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Dean Advantage Balance (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Dean Advantage Balance (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Dean Advantage Balance (HMO-POS) in 2025, please refer to our full plan details page.
Dean Advantage Balance (HMO-POS) is a HMO-POS plan offered by Medica Holding Company available for enrollment in 2025 to people living in South Central Wisconsin. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Dean Advantage Balance (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Dean Advantage Balance (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Dean Advantage Balance (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $102.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3650.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $3650.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Dean Advantage Balance (HMO-POS) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have an $8 copay at preferred pharmacies and $13 at standard pharmacies. The plan also has a catastrophic coverage phase where you pay nothing for Part D covered drugs after your yearly out-of-pocket drug costs reach $2000. If you qualify for the low-income subsidy, your monthly Part D premium will be reduced.
Additional Benefits
The Dean Advantage Balance (HMO-POS) plan offers a variety of benefits. The plan covers inpatient hospital stays with a copay, and outpatient services with varying copays. It also includes coverage for ambulance services, emergency services, primary care, hearing, vision, and dental services. This plan provides coverage for preventive services with no copay, as well as home health services with no copay. Additionally, the plan includes benefits for home infusion, dialysis, and medical equipment. There is a copay for skilled nursing facility services, and additional services such as acupuncture and over-the-counter items are covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-6, and no copay for days 7-90. Inpatient Hospital Psychiatric has the same cost sharing as Inpatient Hospital-Acute. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $400, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a copay between $15 and $25 depending on the session. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Dean Advantage Balance (HMO-POS) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Dean Advantage Balance (HMO-POS) plan. Ground ambulance services have a $300 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year via bus or subway, but transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Dean Advantage Balance (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a copay between $0 and $40; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Dean Advantage Balance (HMO-POS) plan covers primary care, chiropractic services with a $20 copay, occupational therapy with a $40 copay, physician specialist services with a $0-$25 copay, mental health specialty services with a $15-$25 copay, podiatry services with a $25 copay, other health care professional services with a $25 copay, psychiatric services with a $15-$25 copay, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a $0-$25 copay, and opioid treatment program services with a $25 copay.
Preventive Services See details
The Dean Advantage Balance (HMO-POS) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services are partially covered, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services with the Dean Advantage Balance (HMO-POS) plan includes a $25 copay for hearing exams, with coverage for routine hearing exams and fitting/evaluation for hearing aids once per year. Prescription hearing aids are covered up to $750 every year, with all types of prescription hearing aids covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services, including routine eye exams, are covered with no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered, with a combined maximum benefit of $250 every two years.
Dental Services See details
Dental services include a $30 copay for Medicare dental services, and a $1500 maximum plan benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments are covered. Restorative services have a $95 copay, adjunctive general services have a $45 copay, endodontics have a $595 copay, periodontics have a copay between $45 and $595, prosthodontics (removable and fixed) and implant services have a $595 copay, and oral and maxillofacial surgery has a $595 copay. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a copay of $30-$35. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Dean Advantage Balance (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered devices and supplies. Durable Medical Equipment for use outside the home is not covered, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Dean Advantage Balance (HMO-POS) plan, including Diagnostic Procedures/Tests with a $10 copay, and Lab Services with no copay. Radiological Services require prior authorization, and include Diagnostic Radiological Services with a copay of up to $175, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with a $30 copay.
Home Health Services See details
Home Health Services are covered by the Dean Advantage Balance (HMO-POS) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Dean Advantage Balance (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Dean Advantage Balance (HMO-POS) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Dean Advantage Balance (HMO-POS) plan covers acupuncture with a $30 copay for up to 12 treatments per year, over-the-counter items up to $35 every three months, and a meal benefit for chronic illness. Other services include non-transport ambulance service with a $300 copay, and additional home infusion services. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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