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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 2026, 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 3.5 out of 5 stars in 2026.
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 $119.00. 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 $300.00 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 $4200.00 (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 $4200.00 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) prescription drug plan features a $300 annual drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or standard mail order. For Tier 2 generic medications, copays start as low as $14 for a one-month supply at preferred pharmacies and standard mail order. Brand-name and specialty drugs require coinsurance, ranging from 20% for Tier 3 preferred brands to 29% for Tier 5 specialty drugs. Additionally, Tier 6 vaccines are highly accessible with no copay required for a one-month supply at both preferred and standard pharmacies. Using preferred pharmacies or standard mail order consistently offers the lowest out-of-pocket costs for your prescriptions.
Additional Benefits
The Dean Advantage Balance (HMO-POS) plan offers comprehensive coverage with no copays for primary care visits, preventive services, home health care, and ambulatory surgical center services. For inpatient hospital stays, members pay a daily copay for the first five days followed by no copay for subsequent days, all with no coinsurance. Emergency care carries a $150 copay, which is waived if admitted, while urgently needed services range from no copay to $40. Routine hearing and vision exams feature low or no copays, alongside annual allowances for hearing aids and eyewear. Preventive dental services are covered with no copay up to an $800 annual limit, while comprehensive dental care requires no copay and a 50% coinsurance. Additionally, the plan covers durable medical equipment, diagnostic services, and skilled nursing facility stays with varying copays or coinsurance, though cardiac rehabilitation is excluded from coverage.
Inpatient Hospital See details
Dean Advantage Balance (HMO-POS) partially covers inpatient hospital care with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require a $375 copay per day for days 1-5 and no copay for days 6 and beyond, while psychiatric stays require a $350 copay per day for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Dean Advantage Balance (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $400 copay for outpatient hospital services, a $375 copay per stay for observation services, and no copay for ambulatory surgical center services. Outpatient substance abuse services require a $25 copay for individual sessions and a $15 copay for group sessions with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Dean Advantage Balance (HMO-POS) plan with a $100 copay and no coinsurance.
Ambulance and Transportation Services See details
Dean Advantage Balance (HMO-POS) covers ground ambulance services with a $300 copay and air ambulance services with a $475 copay, with no coinsurance required for either service. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations via bus or subway with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Dean Advantage Balance (HMO-POS) covers emergency services with a $150 copay (waived if admitted within 24 hours) and urgently needed services with a copay ranging from no copay to $40, both with no coinsurance. Worldwide emergency and urgent services are partially covered with a $140 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under the Dean Advantage Balance (HMO-POS) plan are covered with no coinsurance, featuring no copay for primary care physician visits. Other covered services, including specialist visits, physical therapy, and chiropractic care, require copays ranging from $0 to $40 with no coinsurance.
Preventive Services See details
Preventive services are covered by Dean Advantage Balance (HMO-POS) with no copay and no coinsurance, including annual physical exams and kidney disease education. Additional preventive services are partially covered under the plan, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, caregiver support, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Dean Advantage Balance (HMO-POS) covers annual routine hearing exams and fitting evaluations with a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $750 annual maximum, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Dean Advantage Balance (HMO-POS) with no coinsurance or deductibles, offering annual eye exams for a $0 to $35 copay. Eyewear is covered with no copay or coinsurance, providing up to a $175 combined annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
Dean Advantage Balance (HMO-POS) partially covers dental services, offering Medicare-covered dental for a $35 copay and no coinsurance, and preventive services with no copay and no coinsurance up to an $800 annual maximum. Comprehensive dental services are covered with no copay and 50% coinsurance, while other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Dean Advantage Balance (HMO-POS) with no copay, while associated Medicare Part B insulin has a $30 to $35 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation, require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Dean Advantage Balance (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Dean Advantage Balance (HMO-POS) with no copays, though prior authorization and coinsurance may apply to certain items. Members will pay no copay and a coinsurance of 0% to 20% for durable medical equipment and diabetic supplies, and a 20% coinsurance for prosthetic devices, medical supplies, and diabetic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Dean Advantage Balance (HMO-POS) with no coinsurance, although lab services are not covered. Covered services include diagnostic procedures and tests for a $10 copay, outpatient X-rays for a $40 copay, therapeutic radiology for a $45 copay, and diagnostic radiology with no 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.
Cardiac Rehabilitation Services See details
Dean Advantage Balance (HMO-POS) does not cover Cardiac Rehabilitation Services, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Dean Advantage Balance (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. The benefit is partially covered, offering no copay for days 1 to 20 and days 42 to 100, a $218 copay for days 21 to 41, and excluding coverage for additional days beyond the standard Medicare-covered limit.
Other Services See details
Other services covered by Dean Advantage Balance (HMO-POS) include acupuncture with a $35 copay and no coinsurance for up to 12 treatments yearly, as well as home infusion and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter items are partially covered with no copay and no coinsurance up to a $25 quarterly reimbursement limit, excluding nicotine replacement therapy and naloxone, while non-transport ambulance services are covered with a $395 copay and no coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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