DeanCare Gold Shared Value (Cost)
H5264 - 005 - 0
(0 / 5)
DeanCare Gold Shared Value (Cost) is a Medicare Advantage (Part C) Plan by Dean Health Plan, Inc..
This page features plan details for 2024 DeanCare Gold Shared Value (Cost) H5264 – 005 – 0 available in South Central Wisconsin.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
DeanCare Gold Shared Value (Cost) is offered in the following locations.
Plan Overview
DeanCare Gold Shared Value (Cost) offers the following coverage and cost-sharing.
| Insurer: | Dean Health Plan, Inc. |
| Health Plan Deductible: | $0.00 |
| MOOP: | Not Applicable |
| Drugs Covered: | No |
Ready to sign up for DeanCare Gold Shared Value (Cost) ?
Premium Breakdown
DeanCare Gold Shared Value (Cost) has a monthly premium of $108.00. 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 | $108.00 | $0.00 | $282.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
DeanCare Gold Shared Value (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 | $10 copay per visit (Not applicable.) (Not applicable.) |
| Specialist | $10 copay per visit (Authorization is not required.) (Referral is not required.) |
| $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $50 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $10 copay per visit (always covered) (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 | $10 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.) |
| $200 per stay (Authorization is not required.) (Referral is not required.) |
| Inpatient hospital – psychiatric | $200 per stay (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 Shared Value (Cost) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
HealthCompare Insurance Services does not offer every plan available in your area. Currently we represent 18 organizations, which offers 52,101 products in your area.
We do not feature every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Enrollment is offered through our partners including HealthCompare Insurance Services Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
HealthCompare Insurance Services represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Medicare has neither approved nor endorsed any information on this site.