DeanCare Gold Basic (Cost)
H5264 - 003 - 0
(5 / 5)
DeanCare Gold Basic (Cost) is a Medicare Advantage (Part C) Plan by Dean Health Plan, Inc..
This page features plan details for 2022 DeanCare Gold Basic (Cost) H5264 – 003 – 0 available in South Central Wisconsin.
IMPORTANT: This page features the 2022 version of this plan. See the 2024 version using the link below:
No 2024 version found. You can use the location links below to find 2024 plans in your area.
Locations
DeanCare Gold Basic (Cost) is offered in the following locations.
Plan Overview
DeanCare Gold Basic (Cost) offers the following coverage and cost-sharing.
| Insurer: | Dean Health Plan, Inc. |
| Health Plan Deductible: | $0 |
| MOOP: | $- |
| Drugs Covered: | No |
Ready to sign up for DeanCare Gold Basic (Cost) ?
Premium Breakdown
DeanCare Gold Basic (Cost) has a monthly premium of $. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $170.10 | $139.00 | $0.00 | $309.10 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
DeanCare Gold Basic (Cost) also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: No |
Dental (comprehensive)
| Diagnostic services: | Not covered |
| Endodontics: | Not covered |
| Extractions: | Not covered |
| Non-routine services: | Not covered |
| Periodontics: | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered |
| Restorative services: | Not covered |
Dental (preventive)
| Cleaning: | Not covered |
| Dental x-ray(s): | Not covered |
| Fluoride treatment: | Not covered |
| Oral exam: | Not covered |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | $0 copay |
| Diagnostic tests and procedures: | $0 copay |
| Lab services: | $0 copay |
| Outpatient x-rays: | $0 copay |
Doctor visits
| Primary: | $0 copay |
| Specialist: | $0 copay |
Emergency care/Urgent care
| Emergency: | $0 copay |
| Urgent care: | $0 copay |
Foot care (podiatry services)
| Foot exams and treatment: | $0 copay |
| Routine foot care: | Not covered |
Ground ambulance
| $0 copay |
Health plan deductible
| $0.00 |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | Not covered |
| Hearing aids – inner ear: | Not covered |
| Hearing aids – outer ear: | Not covered |
| Hearing aids – over the ear: | Not covered |
| Hearing exam: | $0 copay |
Hospital coverage (inpatient)
| $0 copay |
Hospital coverage (outpatient)
| $0 copay |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| Not Applicable |
Medical equipment/supplies
| Diabetes supplies: | $0 copay |
| Durable medical equipment (e.g., wheelchairs, oxygen): | $0 copay |
| Prosthetics (e.g., braces, artificial limbs): | $0 copay |
Mental health services
| Inpatient hospital – psychiatric: | $0 copay |
| Outpatient group therapy visit with a psychiatrist: | $0 copay |
| Outpatient group therapy visit: | $0 copay |
| Outpatient individual therapy visit with a psychiatrist: | $0 copay |
| Outpatient individual therapy visit: | $0 copay |
Optional supplemental benefits
| No |
Preventive care
| $0 copay |
Rehabilitation services
| Occupational therapy visit: | $0 copay |
| Physical therapy and speech and language therapy visit: | $0 copay |
Skilled Nursing Facility
| $0 copay |
Transportation
| Not covered |
Vision
| Contact lenses: | Not covered |
| Eyeglass frames: | Not covered |
| Eyeglass lenses: | Not covered |
| Eyeglasses (frames and lenses): | Not covered |
| Other: | Not covered |
| Routine eye exam: | Not covered |
| Upgrades: | Not covered |
Wellness programs (e.g., fitness, nursing hotline)
| Covered |
Ready to sign up for DeanCare Gold Basic (Cost) ?