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Dean Advantage Essential (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Dean Advantage Essential (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Dean Advantage Essential (HMO) in 2026, please refer to our full plan details page.
Dean Advantage Essential (HMO) is a HMO 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 Essential (HMO) 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 Essential (HMO).
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 Essential (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $615.00 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 Maximum Out-Of-Pocket cost of $6750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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:
Sign up for Dean Advantage Essential (HMO)
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Drug Coverage
The Dean Advantage Essential (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 6 vaccines, you will pay no copay at preferred pharmacies. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a one-month supply at preferred pharmacies or through standard mail order. Higher-tier medications require coinsurance, with Tier 3 preferred brands costing 20% at preferred pharmacies and Tier 4 non-preferred drugs requiring 45% coinsurance. Standard pharmacies generally carry slightly higher costs, such as 25% coinsurance for Tier 3 brands and up to 50% for Tier 4 drugs. Specialty Tier 5 drugs require a 25% coinsurance at both preferred and standard pharmacies for a one-month supply.
Additional Benefits
The Dean Advantage Essential (HMO) plan offers robust coverage with no coinsurance for many key medical services, including inpatient hospital stays, outpatient care, and emergency services. Primary care visits, home health services, and annual physical exams are available with no copay and no coinsurance, while specialist visits require copays ranging up to $50. Emergency care carries a $130 copay, which is waived if you are admitted, while ground ambulance services require a $300 copay. For supplemental care, the plan features routine vision exams and eyewear with no copay up to a $175 annual maximum, alongside hearing aid coverage up to $750. Preventive dental services have no copay up to a $500 yearly limit, while comprehensive dental services require a 50% coinsurance. Additionally, members benefit from a $50 quarterly over-the-counter allowance and up to 24 one-way transportation trips per year with no copay.
Inpatient Hospital See details
Dean Advantage Essential (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute hospital stays require a $395 copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric stays require a $350 copay for days 1 through 6 and no copay for days 7 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Dean Advantage Essential (HMO) with no coinsurance, featuring a copay of $0 to $495 for outpatient hospital services and a $450 copay per stay for observation services. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse services require a copay of $35 for group sessions or $45 for individual sessions with no coinsurance.
Partial Hospitalization See details
Dean Advantage Essential (HMO) covers partial hospitalization services with a $125.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Dean Advantage Essential (HMO) covers ambulance and transportation services, though transportation is only partially covered as trips to any health-related location are not covered. Medicare-covered ground ambulance services require a $300 copay and air ambulance services require a $475 copay with no coinsurance, while up to 24 one-way trips per year to plan-approved locations via bus or subway are provided with no copay and no coinsurance.
Emergency Services See details
Dean Advantage Essential (HMO) covers emergency services with a $130 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, and urgently needed services with no copay to a $50 copay and no coinsurance. Worldwide emergency and urgent services are partially covered with a $125 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Dean Advantage Essential (HMO) covers primary care physician services with no copay and no coinsurance. Specialist visits, physical therapy, mental health, chiropractic, and telehealth services are also covered with no coinsurance and copays ranging from no copay up to $50.
Preventive Services See details
Dean Advantage Essential (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, but health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Dean Advantage Essential (HMO) partially covers hearing services, providing routine exams and fitting evaluations for a $45 copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to a $750 annual maximum, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Dean Advantage Essential (HMO) covers vision services with no deductibles, including routine and refraction eye exams for a $0 to $45 copay and no coinsurance. Eyewear, including contacts, frames, and lenses, is also covered with no copay and no coinsurance up to a $175 annual maximum benefit.
Dental Services See details
Dean Advantage Essential (HMO) offers partially covered dental services, featuring Medicare-covered dental at a $45 copay with no coinsurance, and preventive services with no copay or coinsurance up to a $500 yearly limit. Comprehensive treatments like restorative care, endodontics, periodontics, implants, and oral surgery are covered with no copay and a 50% coinsurance. Other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Dean Advantage Essential (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin drugs require a $30.00 to $35.00 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Dean Advantage Essential (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Dean Advantage Essential (HMO) with no copays, though coinsurance applies to several services. Durable medical equipment and diabetic supplies have no copay and range from no coinsurance up to 20% coinsurance, while prosthetic devices, medical supplies, and diabetic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Dean Advantage Essential (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required for radiological services. Outpatient lab services and diagnostic radiology feature no copay, while diagnostic procedures require a $25 copay, and outpatient X-rays and therapeutic radiology require copays starting at $40.
Home Health Services See details
Home health services are covered under the Dean Advantage Essential (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Dean Advantage Essential (HMO) covers some cardiac rehabilitation services with no coinsurance, though standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Dean Advantage Essential (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 53 to 100, a $218 daily copay for days 21 to 52, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Dean Advantage Essential (HMO) provides coverage for other services, including acupuncture for a $45 copay and no coinsurance (up to 12 treatments yearly), and a $50 quarterly over-the-counter reimbursement benefit with no copay or coinsurance. Additionally, chronic illness meal benefits and home infusion services are covered with no copay or coinsurance, while non-transport ambulance services require a $300 copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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