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Dean Advantage Complete (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Dean Advantage Complete (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Dean Advantage Complete (HMO) in 2026, please refer to our full plan details page.
Dean Advantage Complete (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 Complete (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 Complete (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 Complete (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $256.00. 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 $100.00 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 $2750.00 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:
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Drug Coverage
The Dean Advantage Complete (HMO) prescription drug plan features a low $100 annual drug deductible and affordable options for generic medications. Tier 1 preferred generic drugs have no copay when filled at a preferred pharmacy or through standard mail order, compared to a $7 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs carry a $15 copay for a one-month supply at preferred pharmacies and standard mail order, or a $20 copay at standard pharmacies. For brand-name and specialty medications, your costs are determined by coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance at preferred pharmacies and standard mail order, while Tier 4 non-preferred drugs carry a 45% coinsurance. Tier 5 specialty drugs have a 31% coinsurance for a one-month supply, whereas Tier 6 vaccines are highly accessible with no copay at both preferred and standard pharmacies.
Additional Benefits
The Dean Advantage Complete (HMO) plan offers comprehensive medical coverage with predictable, low-cost sharing, including no copays or coinsurance for primary care visits and routine home health services. Specialist visits, urgent care, and annual preventive physicals are also highly affordable, featuring copays ranging from no copay to $25. For major medical needs, emergency care carries a $150 copay, while inpatient hospital stays require a $350 daily copay for the first five days and no copay for days six through 90. This plan also delivers robust routine benefits, including no copays for preventive dental care up to $1,500 annually and no copays for eyewear up to a $175 yearly limit. Routine hearing exams carry a $25 copay, while prescription hearing aids are covered with no copay up to a $750 annual maximum. Additionally, members benefit from no copays for skilled nursing facility stays for days 1 through 20 and a $35 quarterly over-the-counter allowance.
Inpatient Hospital See details
Dean Advantage Complete (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute days are covered at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Dean Advantage Complete (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay, and outpatient hospital services with copays ranging from $0 to $300. Observation services have a $350 copay per stay, while outpatient substance abuse services require a copay of $10 for group sessions and $15 for individual sessions.
Partial Hospitalization See details
Partial hospitalization services are covered by the Dean Advantage Complete (HMO) plan with an $85.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Dean Advantage Complete (HMO) covers ambulance services with no coinsurance and a copay of $300 for ground transport and $475 for air transport. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year via bus or subway to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Dean Advantage Complete (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay to a $25 copay and no coinsurance, while worldwide emergency and urgent services are partially covered with a $140 copay and no coinsurance, excluding worldwide emergency transportation.
Primary Care See details
Dean Advantage Complete (HMO) covers primary care physician services with no copay and no coinsurance, while specialist and telehealth visits feature copays from $0 to $25 with no coinsurance. Other covered services, such as therapy, chiropractic, podiatry, and mental health care, have copays ranging from $10 to $45 and no coinsurance.
Preventive Services See details
Preventive services are covered by Dean Advantage Complete (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, and select additional services like fitness and in-home support. 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, palliative care, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Dean Advantage Complete (HMO) covers routine hearing exams and evaluations for a $25 copay and no coinsurance, as well as prescription hearing aids with no copay or coinsurance up to a $750 annual maximum. This benefit is partially covered, as OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Dean Advantage Complete (HMO), featuring annual routine and refraction eye exams with a $0 to $25 copay and no coinsurance. Eyewear is covered with no copay and no coinsurance, providing up to a $175 combined maximum benefit per year for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Dean Advantage Complete (HMO), featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care up to a $1,500 annual limit. Comprehensive dental services, such as endodontics and implants, are covered with no copay and 50% coinsurance, while other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Dean Advantage Complete (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $30.00 to $35.00 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Dean Advantage Complete (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Dean Advantage Complete (HMO) covers medical equipment with no copay, though prior authorization is required for some services. Coinsurance ranges from no coinsurance up to 20% for durable medical equipment and diabetic supplies, while prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Dean Advantage Complete (HMO) partially covers diagnostic and radiological services with no coinsurance, though lab services are not covered. Covered diagnostic tests require a $5 copay, while radiological services require prior authorization and range from no copay for diagnostic radiology to a $25 copay for therapeutic radiology and a $30 copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the Dean Advantage Complete (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Dean Advantage Complete (HMO) provides cardiac rehabilitation services with no coinsurance, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered under this benefit and require copays ranging from $25 to $30.
Skilled Nursing Facility (SNF) See details
Dean Advantage Complete (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and days 35 to 100, while days 21 to 34 require a $218 daily copay.
Other Services See details
Other Services covered by Dean Advantage Complete (HMO) include acupuncture for a $25 copay and no coinsurance (up to 24 treatments per year), alongside chronic illness meals and home infusion services with no copay and no coinsurance. A $35 quarterly over-the-counter reimbursement is provided with no copay and no coinsurance, though nicotine replacement therapy and naloxone are not covered, while non-transport ambulance services are covered with a $395 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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