DeanCare Gold Enhanced (Cost) is a Medicare Advantage (Part C) Plan by Dean Health Plan, Inc..
This page features plan details for 2024 DeanCare Gold Enhanced (Cost) H5264 – 002 – 0 available in South Central Wisconsin.
IMPORTANT: This page has been updated with plan and premium data for 2024.
DeanCare Gold Enhanced (Cost) is offered in the following locations.
DeanCare Gold Enhanced (Cost) offers the following coverage and cost-sharing.
Insurer: | Dean Health Plan, Inc. |
Health Plan Deductible: | $0.00 |
MOOP: | Not Applicable |
Drugs Covered: | No |
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Part B | Part C | Part B Give Back | Total |
---|---|---|---|
$174.70 | $172.00 | $0.00 | $346.70 |
DeanCare Gold Enhanced (Cost) also provides the following benefits.
$0 |
In-network | Yes |
Not Applicable |
No |
In-network | No |
$0 copay (Authorization is not required.) (Referral is not required.) |
Primary | $0 copay (Not applicable.) (Not applicable.) |
Specialist | $0 copay (Authorization is not required.) (Referral is not required.) |
$0 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $0 copay (Not applicable.) (Not applicable.) |
Urgent care | $0 copay (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $0 copay (Authorization is not required.) (Referral is not required.) |
Lab services | $0 copay (Authorization is not required.) (Referral is not required.) |
Diagnostic radiology services (e.g., MRI) | $0 copay (Authorization is not required.) (Referral is not required.) |
Outpatient x-rays | $0 copay (Authorization is not required.) (Referral is not required.) |
Hearing exam | $0 copay (Authorization is not required.) (Referral is not required.) |
Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Hearing aids | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Non-routine services | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Diagnostic services | 0-50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Restorative services | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Endodontics | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Periodontics | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Extractions | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Prosthodontics, other oral/maxillofacial surgery, other services | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
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.) |
Contact lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
Occupational therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
Physical therapy and speech and language therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
$0 copay (Not applicable.) (Not applicable.) |
Not covered (Not applicable.) (Not applicable.) |
Foot exams and treatment | $0 copay (Authorization is not required.) (Referral is not required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay (Authorization is not required.) (Not applicable.) |
Prosthetics (e.g., braces, artificial limbs) | $0 copay (Authorization is not required.) (Not applicable.) |
Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | $0 copay (Not applicable.) (Not applicable.) |
Other Part B drugs | $0 copay (Not applicable.) (Not applicable.) |
Part B Insulin drugs | $0 copay (Not applicable.) (Not applicable.) |
$0 copay (Authorization is not required.) (Referral is not required.) |
Inpatient hospital – psychiatric | $0 copay (Authorization is not required.) (Referral is not required.) |
Outpatient group therapy visit with a psychiatrist | $0 copay (Authorization is not required.) (Referral is not required.) |
Outpatient individual therapy visit with a psychiatrist | $0 copay (Authorization is not required.) (Referral is not required.) |
Outpatient group therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
Outpatient individual therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
$0 copay (Authorization is not required.) (Referral is not required.) |
Ready to sign up for DeanCare Gold Enhanced (Cost) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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