Medicare Advantage plan details

Our plans

Medicare Advantage plans include medical, prescription drug and dental coverage. Some plans also have added benefits, such as vision, hearing, wellness rewards and gym membership. You can enroll in a 2021 plan if you are new to Medicare or qualify for a special enrollment period.

Request a kit

You can get a free enrollment kit with details about our Medicare Advantage plans or make a request to meet with a salesperson.


2021 benefit tables


2021 benefit overview

Prevea Essential

$
0
Monthly Premium
  • Part B premium reduction
    (it's like a monthly raise in your Social Security check) $25
  • Hospital copay per day
    In-network: $325 per day for days 1-5 $0 per day for days 6 - discharge
    Out-of-network: $500 per day for days 1-7 $0 per day for days 8 - discharge
  • Primary care doctor's office copay
    In-network: $0 Out-of-network: $30
  • Specialist visit copay
    In-network: $45 Out-of-network: $60
  • Visit (Includes world-wide coverage)
    $90
  • Urgent care visit
    $45
  • Ambulance transportation
    In-network: $250 Out-of-network coinsurance 40%
  • Therapy (physical, occupation, and speech)
    In-network: $40 Out-of-network: $60
  • Maximum out-of-pocket
    In-network: $4,500 In and out combined: $6,000

Prevea Complete

$
226
Monthly Premium
  • Part B premium reduction
    (it's like a monthly raise in your Social Security check) $0
  • Hospital copay per day
    In-network: $325 per day for days 1-5 $0 per day for days 6 - discharge
    Out-of-network: $500 per day for days 1-7 $0 per day for days 8 - discharge
  • Primary care doctor's office copay
    In-network: $0 Out-of-network: $30
  • Specialist visit copay
    In-network: $10 Out-of-network: $60
  • Visit (Includes world-wide coverage)
    $120
  • Urgent care visit
    $10
  • Ambulance transportation
    In-network: $250 Out-of-network coinsurance 40%
  • Therapy (physical, occupation, and speech)
    In-network: $10 Out-of-network: $60
  • Maximum out-of-pocket
    In-network: $2,500 In and out combined: $5,000

Prevea Harmony

$
0
Monthly Premium
  • Part B premium reduction
    (it's like a monthly raise in your Social Security check) $75
  • Hospital copay per day
    In-network: $300 per day for days 1-5 $0 per day for days 6 - discharge
    Out-of-network : $500 per day for days 1-7 $0 per day for days 8 - discharge
  • Primary care doctor's office copay
    In-network: $0 Out-of-network: $30
  • Specialist visit copay
    In-network: $45 Out-of-network: $60
  • Visit (Includes world-wide coverage)
    $90
  • Urgent care visit
    $45
  • Ambulance transportation
    In-network: $250 Out-of-network coinsurance 40%
  • Therapy (physical, occupation, and speech)
    In-network: $40 Out-of-network: $60
  • Maximum out-of-pocket
    In-network: $40 Out-of-network: $60


2021 additional benefit overview


All plans include:


Preventive dental


Preventive Exams: $0 copay per visit for 2 visits every calendar year
Cleanings: $0 copay per visit for 2 visits every calendar year
X-Ray: $0 copay per visit for 1 visit every calendar year
Comprehensive dental

Diagnostic Services: $0 copay
Periodontics Maintenance/Emergency Services/Non-Routine Services: $45 copay
Filings/Periodontics/Extractions: $95 copay
Crowns/Dentures/Implants/ Endodontics/Root Canals: $595 copay
Annual limit that Dean Health Plan will pay for preventive and comprehensive dental services: $1,500 every calendar year for dental services

In-home and virtual support and companionship

$0 copay for up to 10 hours of services per month

Over-the-counter items

$60 allowance per quarter

Hearing aid

Plan pays $750 yearly

Eyeglasses/contacts

Plan pays $200 yearly

Transportation

$0 copay for up to 24 one way trips per year

Meal benefit

$0 copay for 14 meals after inpatient discharge

Gym and at-home fitness benefit

Fully covered yearly


Nurse line (Prevea After Hours)

$0
Living healthy rewards

Earn up to $150 per year


2021 Part D benefit overview 



Essential

CompleteHarmony

Part D Deductible
Applies to Tiers 3-5

$250$0Not covered

Preferred Retail:
Tier 1 Preferred Generic

$0$0Not covered

Preferred Retail:
Tier 2 Generic

$5 copay$5 copayNot covered

Preferred Retail:
Tier 3 Preferred Brand

$40 copay
$40 copayNot covered

Preferred Retail:
Tier 4 Non-preferred Drugs

$90 copay
$90 copay
Not covered

Preferred Retail:
Tier 5 Specialty Drugs

28% coinsurance
33% coinsurance
Not covered

Preferred Retail:
Tier 6 Part D Vaccines
(Tdap, Shingrix, and Zostavax)

$0 copay$0 copayNot covered

Standard Retail:
Tier 1 Preferred Generic

$7 copay$7 copayNot covered

Standard Retail:
Tier 2 Generic

$12 copay$12 copayNot covered

Standard Retail:
Tier 3 Preferred Brand

$47 copay
$47 copay
Not covered

Standard Retail:
Tier 4 Non-preferred Drugs

$100 copay
$100 copay
Not covered

Standard Retail:
Tier 5 Specialty Drugs

28% coinsurance
33% coinsurance
Not covered

Standard Retail:
Tier 6 Part D Vaccines
(Tdap, Shingrix, and Zostavax

$0 copay$0 copayNot covered



Plan Guide

Detailed coverage and benefit information for Prevea360 Medicare Advantage. 


Summary of Benefits

Summarized benefit information for Prevea360 Medicare Advantage plans.


Application

Apply online or complete a paper form. Send completed form to:

Dean Health Plan
MAPD Enrollment
PO Box 851078
Richardson, TX 75085-1078


Questions?

Members: speak with Customer Care Center at 1-877-232-7566 (TTY: 711)
Not a member? Talk with a sales representative at 1-877-234-0126 (TTY: 711), including for alternate formats and languages.


Mailing Address:

Prevea360 Medicare Advantage
PO Box 56099
Madison, WI 53705

View our Medicare disclaimer.
H9096_prevea360.com
Updated: 7/22/2021