Skip to Content

Published on October 09, 2014

Frequently Asked Questions

How can I compare my options?
You can compare the DeanCare Gold plans and the original Medicare Plan using this Summary of Benefits chart. The charts on this website list some important health benefits. For each benefit, you can see what our plan covers and what the Original Medicare Plan covers. Our members receive all of the benefits that the Original Medicare Plan offers. We also offer more benefits, which may change from year to year.

Back to Top

Where is DeanCare Gold available?
The service area for this plan includes: Columbia, Dane, Dodge, Grant, Iowa, Jefferson, Rock and Sauk Counties, WI. You must live in one of these areas to join the plan.

Back to Top

Who is eligible to join DeanCare Gold?
You can join DeanCare Gold if you are entitled to Medicare Part A and enrolled in Part B or enrolled in Medicare Part B only and live in the service area. However, individuals with End-Stage Renal Disease generally are not eligible to enroll in DeanCare Gold unless they are members of our organization and have been since their dialysis began.

Back to Top

Can I choose my doctors?
DeanCare Gold has formed a network of doctors, specialists and hospitals. You can use any doctor who is part of our network. You may also go to doctors outside of our network. The health providers in our network can change at any time. You can ask for a current provider directory by contacting our customer service number or you can search our provider directory online.

Back to Top

What happens if I go to a doctor who's not in your network?
You can always choose to go to a doctor outside our network. We may not pay for the services you receive outside of our network, but Medicare will pay for its share of charges it approves. You will be responsible for Medicare Part B deductible and co-insurance.

Back to Top

Does my plan cover medicare Part B or Part D drugs?
DeanCare Gold does cover Part B prescriptions drugs. DeanCare Gold does NOT cover Medicare Part D prescriptions drugs.

Back to Top

What are my protections in this plan?
All Medicare Cost Plans agree to stay in the program for a full calendar year at a time. Plan benefits and cost-sharing may change from calendar year to calendar year. Each year, plans can decide whether to continue for another year. A plan may continue in their entire service area (geographic area where the plan accepts members) or choose to continue only in certain areas. Also, Medicare may decide to end a contract with a plan. Even if your Medicare Cost Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue for an additional calendar year, it must send you a letter at least 60 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.

As a member of DeanCare Gold, you have the right to request an organization determination, which includes the right to file an appear if we deny coverage for an item or service, and the right to file a grievance. You have the right to request an organization determination if your want us to provide or pay for an item or service that you believe should be covered. If we deny coverage for your requested item or service, you have the right to appeal and ask us to review our decision. You may ask us for an expedited (fast) coverage determination or appeal if you believe that waiting for a decision could seriously put your life or health at risk, or affect your ability to regain maximum function. If your doctor makes or supports the expedited request, we must expedite our decision. Finally, you have the right to file a grievance with us if you have any type of problem with us or one of our network providers that does not involve coverage for an item or service. If your problem involves quality of care, you also have the right to file a grievance with the Quality Improvement Organization (QIO) for your state. Please refer to the Evidence of Coverage (EOC) for the QIO contact information.

Back to Top

What types of drugs may be covered under Medicare Part B?
Some outpatient prescription drugs may be covered under Medicare Part B. These may include, but are not limited to, the following types of drugs. Contact DeanCare Gold for more details.

  • Some Antigens: if they are prepared by a doctor and administered by a properly instructed person (who could be the patient) under doctor supervision.
  • Osteoporosis Drugs: Injectable drugs for osteoporosis for certain women with Medicare.
  • Erythropoietin (Epoetin Alfa or Epogen(r)): By injection if you have end-stage renal disease (permanent kidney failure requiring either dialysis or transplantation) and need this drug to treat anemia.
  • Hemophilia Clotting Factors: Self-administered clotting factors if you have hemophilia.
  • Injectable Drugs: Most injectable drugs administered incident to a physician's service.
  • Immunosupressive Drugs: Immunosuppressive drug therapy for transplant patients if the transplant was paid for by Medicare, or paid by a private insurance that paid as a primary payer to your Medicare Part A coverage, in a Medicare-certified facility.
  • Some Oral Cancer Drugs: If the same drug is available in injectable form.
  • Oral Anti-Nausea Drugs: If you are part of an anti-cancer chemotherapeutic regimen.
  • Inhalation and Infusion Drugs administered through DME.

Back to Top

Where can I find information on plan ratings?
The Medicare program rates how well plans perform in different categories (for example, detecting and preventing illness, ratings from patients and customer service). If you have access to the web, you may use the web tools on www.medicare.gov and select "Health and Drug Plans" then "Compare Drug and Health Plans" to compare the plan ratings for Medicare plans in your area. You can also call us directly to obtain a copy of the plan ratings for this plan.

Back to Top

H5264_WEB15v1_CMS Approved
DeanCare Gold (Cost) is an HMO plan with a Medicare contract.  Enrollment in DeanCare Gold depends on contract renewal.

We're Here to Help!

If you are new to DeanCare Gold or DeanCare Select, have questions about signing up or would like assistance completing the application forms, please contact one of our licensed insurance agent/brokers below.

Laura IversonLaura Iverson
(800) 356-7344,
ext. 4129
laura.iverson@deancare.com

Mary OlsonMary Olson
(800) 356-7344,
ext. 4242
mary.olson@deancare.com

If you are a current DeanCare Gold or DeanCare Select member and have questions about your coverage, please contact the Customer Care Center at (888) 422-3326, TTY users dial 711.

Oct 1, 2014 – Feb 14, 2015
Mon – Sun 8 a.m. to 8 p.m.

Feb 15, 2015 – Sept 30, 2015
Mon – Fri 8 a.m. to 8 p.m.

For DeanCare Gold information in alternate formats and languages, please call our Customer Care Center.

Mailing Address:
Dean Health Plan
P.O. Box 56099
Madison, WI 53705

APPLY TODAY!

Happy CoupleEach of the following forms must be completed and mailed or faxed to Dean Health Plan, Inc.

2015 Enrollment Forms

Application Instructions

Enrollment Application Form

Automatic Transfer of Funds

Acknowledgment Form

Notice to Applicant

DeanCare Gold Provider Directory


Get Adobe Reader

Eyeglass and Hearing Aid Benefit

Dean Health Plan provides coverage for hearing aids and eyeglasses for Enhanced and Shared Value DeanCare Gold members. Note: this benefit does not apply to the DeanCare Gold Basic plan.

Plan Eyeglasses Providers

Plan Hearing Aid Providers

mail me