Dean Advantage Harmony (HMO-POS)
H9096 - 010 - 0
(4.5 / 5)
Dean Advantage Harmony (HMO-POS) is a Medicare Advantage (Part C) Plan by Dean Advantage, Prevea360 Medicare Advantage.
This page features plan details for 2024 Dean Advantage Harmony (HMO-POS) H9096 – 010 – 0 available in South Central and North Eastern Wisconsin.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Dean Advantage Harmony (HMO-POS) is offered in the following locations.
Plan Overview
Dean Advantage Harmony (HMO-POS) offers the following coverage and cost-sharing.
| Insurer: | Dean Advantage, Prevea360 Medicare Advantage |
| Health Plan Deductible: | $0.00 |
| MOOP: | $4,900.00 |
| Drugs Covered: | No |
Ready to sign up for Dean Advantage Harmony (HMO-POS) ?
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Dean Advantage Harmony (HMO-POS) qualifies for a monthly Medicare Give Back Benefit of $25.00.
| Premium Reduction: | $25.00 |
Premium Breakdown
Dean Advantage Harmony (HMO-POS) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $25.00 | $149.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Dean Advantage Harmony (HMO-POS) also provides the following benefits.
| $0 |
| In-network | No |
| $8,000 In and Out-of-network $4,900 In-network |
| No |
| In-network | No |
| In-network | $0-350 copay per visit (Authorization is required.) (Referral is not required.) |
| out-of-network | 40% coinsurance per visit (Authorization is required.) (Referral is not required.) |
| In-network Primary | $0 copay (Not applicable.) (Not applicable.) |
| out-of-network Primary | 40% coinsurance per visit (Not applicable.) (Not applicable.) |
| In-network Specialist | $0-40 copay per visit (Authorization is not required.) (Referral is not required.) |
| out-of-network Specialist | 40% coinsurance per visit (Authorization is not required.) (Referral is not required.) |
| In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| Emergency | $110 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $0-40 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| In-network Diagnostic tests and procedures | $0-40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Diagnostic tests and procedures | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Lab services | $0-25 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Lab services | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Diagnostic radiology services (e.g., MRI) | $0-200 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic radiology services (e.g., MRI) | 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient x-rays | $30 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient x-rays | 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Hearing exam | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Hearing exam | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Hearing aids | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Non-routine services | $45 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Diagnostic services | $0-45 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Restorative services | $95 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Endodontics | $595 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Periodontics | $45-595 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Extractions | $95 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Prosthodontics, other oral/maxillofacial surgery, other services | $595 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Upgrades | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Occupational therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Occupational therapy visit | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Physical therapy and speech and language therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Physical therapy and speech and language therapy visit | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network | $290 copay (Not applicable.) (Not applicable.) |
| out-of-network | $290 copay (Not applicable.) (Not applicable.) |
| In-network | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Foot exams and treatment | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Foot exams and treatment | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Routine foot care | $40 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
| out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 40% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| out-of-network Prosthetics (e.g., braces, artificial limbs) | 40% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
| out-of-network Diabetes supplies | 40% coinsurance per item (Authorization is not required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| In-network Chemotherapy | $0-47 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Chemotherapy | 40% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Other Part B drugs | 40% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Part B Insulin drugs | $30-35 copay (Authorization is required.) (Not applicable.) |
| out-of-network Part B Insulin drugs | 40% coinsurance (Authorization is required.) (Not applicable.) |
| In-network | $350 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| out-of-network | 40% per stay 40% per day for days 1 through 5 0% per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| In-network Inpatient hospital – psychiatric | $350 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| out-of-network Inpatient hospital – psychiatric | 40% per stay 40% per day for days 1 through 5 0% per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit with a psychiatrist | $30 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit with a psychiatrist | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit with a psychiatrist | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient group therapy visit | $30 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network | $0 per day for days 1 through 20 $203 per day for days 21 through 100 (Authorization is required.) (Referral is not required.) |
| out-of-network | 40% per day for days 1 through 100 (Authorization is required.) (Referral is not required.) |
Ready to sign up for Dean Advantage Harmony (HMO-POS) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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