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Dean Advantage Harmony (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Dean Advantage Harmony (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 Harmony (HMO-POS) in 2025, please refer to our full plan details page.
Dean Advantage Harmony (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 Harmony (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Dean Advantage Harmony (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 Harmony (HMO-POS), 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. Additionally, this plan comes with a Part B Premium reduction of $15.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8000.00 (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 $8000.00 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
Prescription drugs are not covered by Dean Advantage Harmony (HMO-POS).
Additional Benefits
The Dean Advantage Harmony (HMO-POS) plan offers a wide range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays depending on the service. Primary care, hearing, vision, and dental services are also covered, with copays ranging from $0 to $595. Emergency, ambulance, and transportation services are included, with some services having a copay and others having coinsurance. This plan also covers preventive services, home health, and skilled nursing facility services, with specific copays for some services. Additional benefits include coverage for home infusion services, dialysis, medical equipment, diagnostic and radiological services, and other services like acupuncture. However, some services like certain hearing aids, maxillofacial prosthetics, and orthodontics are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Dean Advantage Harmony (HMO-POS) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-5, there is a $350 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $450, and observation services with a $450 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services are covered with a copay of $40 for individual sessions, and $30 for group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Dean Advantage Harmony (HMO-POS) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Dean Advantage Harmony (HMO-POS) plan. Ground ambulance services have a $300 copay, while air ambulance services have 20% coinsurance. Transportation Services to any health-related location are covered for up to 24 one-way trips per year via bus or subway. Transportation Services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Dean Advantage Harmony (HMO-POS). Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a copay between $0 and $40; there is no coinsurance for any of these services. Worldwide Urgent Coverage also has a $110 copay, but Worldwide Emergency Transportation is not covered.
Primary Care See details
Under the Dean Advantage Harmony (HMO-POS) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Chiropractic services have a $20 copay, occupational therapy services have a $40 copay, physician specialist services have a $0-$40 copay, mental health specialty services have a $30-$40 copay, podiatry services have a $40 copay, other health care professional services have a $40 copay, psychiatric services have a $30-$40 copay, physical therapy and speech-language pathology services have a $40 copay, additional telehealth benefits have a $0-$40 copay, and opioid treatment program services have a $40 copay.
Preventive Services See details
The Dean Advantage Harmony (HMO-POS) plan covers preventive services, including annual physical exams, additional preventive services, kidney disease education services, and other preventive services. This plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services. The plan covers in-home support services, smoking and tobacco cessation counseling (5 visits), fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
Hearing Services include Routine Hearing Exams with a $40 copay, and Fitting/Evaluation for Hearing Aid, each covered once per year. Prescription Hearing Aids are covered up to $750 per year, however, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
The Dean Advantage Harmony (HMO-POS) plan covers vision services, including eye exams with no copay, and routine eye exams once per year. Eyewear is covered with a combined maximum benefit of $250 every two years, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Dean Advantage Harmony (HMO-POS) plan covers dental services, including oral exams with a $40 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments. Restorative services have a $95 copay, and Adjunctive General Services, Endodontics, Prosthodontics (removable), Implant Services, Prosthodontics (fixed), and Oral and Maxillofacial Surgery have 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 by the Dean Advantage Harmony (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a $40 copay for diagnostic procedures and tests. Lab services have no copay. Diagnostic Radiological Services have a maximum copay of $200, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Dean Advantage Harmony (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 covered by the Dean Advantage Harmony (HMO-POS) plan. However, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Dean Advantage Harmony (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $40 copay, over-the-counter items with a $30 maximum benefit every three months, a meal benefit for chronic illness, ambulance service for non-transport with a $300 copay, and additional home infusion services. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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