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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 2026, 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 3.5 out of 5 stars in 2026.
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 $20.00. 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 $5000.00 (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 $5000.00 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 comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive exams, and home health services. For inpatient hospital stays, members pay no coinsurance and a copay of $350 to $400 for the first six days, after which there is no copay. Outpatient hospital services feature copays ranging from no copay up to $425, while emergency room visits require a $130 copay that is waived upon admission. Supplemental benefits include routine vision and hearing exams with low copays, alongside annual allowances of $175 for eyewear and $750 for hearing aids. Dental care is covered up to a $1,500 annual maximum, featuring no copay for preventive services and a 50% coinsurance for comprehensive procedures. Additionally, the plan provides a $40 quarterly over-the-counter allowance and up to 24 free one-way transportation trips to approved health-related locations with no copay.
Inpatient Hospital See details
Dean Advantage Harmony (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $400 copay for days 1 through 6 for acute care and a $350 copay for days 1 through 6 for psychiatric care, with no copay for days 7 through 90. While unlimited additional acute care days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Dean Advantage Harmony (HMO-POS) covers outpatient services with no coinsurance, featuring a copay of $0 to $425 for outpatient hospital services and $400 per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $30 copay for individual sessions and a $20 copay for group sessions with no coinsurance.
Partial Hospitalization See details
Dean Advantage Harmony (HMO-POS) covers partial hospitalization services with a copayment of $105.00 and no coinsurance.
Ambulance and Transportation Services See details
Dean Advantage Harmony (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 health-related 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 Harmony (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a range of no copay to a $40 copay and no coinsurance. Worldwide emergency and urgent services are partially covered with a $110 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Dean Advantage Harmony (HMO-POS) covers primary care physician services with no copay and no coinsurance. Additional covered services, including specialist visits, physical therapy, chiropractic care, and mental health services, have copays ranging from $0 to $40 and no coinsurance.
Preventive Services See details
Dean Advantage Harmony (HMO-POS) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering fitness benefits and in-home support, while sub-services such as health education, weight management programs, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are covered by Dean Advantage Harmony (HMO-POS) with a $40 copay and no coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $750 annual limit, excluding inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids.
Vision Services See details
Dean Advantage Harmony (HMO-POS) covers annual routine eye exams and refractions with a copay ranging from $0 to $40 and no coinsurance. Eyewear is also covered with no copay, no coinsurance, and no deductible, up to a $175 annual maximum limit.
Dental Services See details
Dean Advantage Harmony (HMO-POS) provides partially covered dental services up to a $1,500 annual maximum, excluding other preventive dental services, maxillofacial prosthetics, and orthodontics. Medicare-covered dental has a $40 copay and no coinsurance, preventive services have no copay and no coinsurance, and covered comprehensive services require no copay and a 50% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Dean Advantage Harmony (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $30 to $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Dean Advantage Harmony (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Dean Advantage Harmony (HMO-POS) covers medical equipment with no copays, though prior authorization and coinsurance may apply. Durable medical equipment and diabetic supplies range from no coinsurance to 20% coinsurance, while prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Dean Advantage Harmony (HMO-POS) partially covers diagnostic and radiological services with no coinsurance, though lab services are not covered. Diagnostic procedures, therapeutic radiology, and outpatient X-rays require a $40 copay, while diagnostic radiology has no copay and radiological services require prior authorization.
Home Health Services See details
Home Health Services are covered under the Dean Advantage Harmony (HMO-POS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Dean Advantage Harmony (HMO-POS) covers cardiac rehabilitation services with no coinsurance, though only some services are covered; standard cardiac rehabilitation ($35 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($25 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Dean Advantage Harmony (HMO-POS) with no coinsurance, though prior authorization is required and additional days beyond the standard 100 days are not covered. There is no copay for days 1 to 20 and days 45 to 100, while days 21 to 44 require a $218 copay.
Other Services See details
Dean Advantage Harmony (HMO-POS) covers other services including acupuncture for a $40 copay and no coinsurance up to 12 treatments annually, alongside a chronic illness meal benefit and home infusion services with no copay or coinsurance. An OTC benefit is covered with no copay or coinsurance up to a $40 quarterly reimbursement limit, while non-transport ambulance services are available for 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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