2027 Medicare Cost plan

DeanCare Gold Shared Value (Cost): 2027 benefits and costs

Dean Health Plan, Inc. Cost

CMS plan ID: H5264-005-0 · Plan year: 2027

DeanCare Gold Shared Value (Cost) is a 2027 Medicare Cost plan offered by Dean Health Plan, Inc.. It is listed in Wisconsin.

2027 plan costs at a glance

Monthly plan premium$128.00

In-network medical out-of-pocket maximum$7,900.00

Organization: Dean Health Plan, Inc.
Plan organization: DEAN HEALTH PLAN, INC.
Parent company: Medica Holding Company
Plan type: Cost
Part C premium: $128.00
Prescription drug coverage: No
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
In-network medical maximum: $7,900.00
Applies to certain in-network supplemental services.

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$10.00 copay Service-specific deductible No
Specialist visit	$10.00 copay Service-specific deductible No	Approval required No Referral required No
Emergency care	$50.00 copay
Urgent care	$10.00 copay
Home health	$0 Service-specific deductible No	Approval required No Referral required No
Dialysis	$0 Service-specific deductible No	Approval required No Referral required No
Kidney disease education services	$0 Service-specific deductible No	Approval required No Referral required No
Medicare-covered chiropractic	$10.00 copay Service-specific deductible No	Approval required No Referral required No
Medicare-covered foot care	$10.00 copay Service-specific deductible No	Approval required No Referral required No
Other health professionals	$10.00 copay Service-specific deductible No	Approval required No Referral required No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$200.00 copay per stay	Approval required No Referral required No Benefit period Original Medicare
Inpatient mental health care	$200.00 copay per stay	Approval required No Referral required No Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$0 Service-specific deductible No
Hospital observation services	$0 Service-specific deductible No
Ambulatory surgical center	$0 Service-specific deductible No	Approval required No Referral required No
Outpatient blood	$0 Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$0 Service-specific deductible No	Approval required No Referral required No
Laboratory services	$0 Service-specific deductible No	Approval required No Referral required No
Diagnostic radiology (CT, MRI)	$0 Service-specific deductible No	Approval required No Referral required No
Therapeutic radiology	$0 Service-specific deductible No	Approval required No Referral required No
X-rays	$0 Service-specific deductible No	Approval required No Referral required No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	$0 Service-specific deductible No	Approval required No Referral required No
Intensive outpatient program	$0 Service-specific deductible No	Approval required No Referral required No
Substance use treatment, individual sessions	$0 Service-specific deductible No	Approval required No Referral required No
Substance use treatment, group sessions	$0 Service-specific deductible No	Approval required No Referral required No
Opioid treatment program	$0 Service-specific deductible No	Approval required No Referral required No
Mental health, individual sessions	$0 Service-specific deductible No	Approval required No Referral required No
Mental health, group sessions	$0 Service-specific deductible No	Approval required No Referral required No
Psychiatry, individual sessions	$0 Service-specific deductible No	Approval required No Referral required No
Psychiatry, group sessions	$0 Service-specific deductible No	Approval required No Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$0 Service-specific deductible No	Approval required No Referral required No
Physical and speech therapy	$0 Service-specific deductible No	Approval required No Referral required No
Cardiac rehabilitation	$0 Service-specific deductible No	Approval required No Referral required No
Intensive cardiac rehabilitation	$0 Service-specific deductible No	Approval required No Referral required No
Pulmonary rehabilitation	$0 Service-specific deductible No	Approval required No Referral required No
Supervised exercise for peripheral artery disease	$0 Service-specific deductible No	Approval required No Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$0 Service-specific deductible No	Approval required No
Air ambulance	$0 Service-specific deductible No	Approval required No
Durable medical equipment	$0 Service-specific deductible No	Approval required No
Prosthetic devices	$0 Service-specific deductible No	Approval required No
Medical supplies	$0 Service-specific deductible No	Approval required No
Diabetic supplies	$0 Service-specific deductible No	Approval required No
Diabetic shoes and inserts	$0 Service-specific deductible No	Approval required No
Diabetic monitors	0% to 20% coinsurance Service-specific deductible No	Approval required No

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	$0
Oral examsAdditional plan benefit	$0
Dental X-raysAdditional plan benefit	$0
Dental cleaningAdditional plan benefit	$0
Other preventive dentalAdditional plan benefit	$0

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0 Service-specific deductible No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0	Approval required No Referral required No
Medicare-covered eyewear	$0 Service-specific deductible No	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglass framesAdditional plan benefit	$0	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$0 Service-specific deductible No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Over-the-counter hearing aidsAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Limited-duration mealsAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Annual physical examAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Prescription drug coverage

This plan does not include a Part D prescription drug benefit.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.