Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H5264-005

Medicare Plan

DeanCare Gold Shared Value (Cost) · Dean Health Plan, Inc. · 1876 Cost · Select counties in south central WI

Full CMS plan ID: H5264-005-000

H5264-005-000 is the full CMS identifier for the H5264-005 Medicare plan. Common searches include H5264 005 and H5264005.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

DeanCare Gold Shared Value (Cost)

H5264-005-000 Select counties in south central WI 1876 Cost

At-a-glance

Quick view

01

In-network

Inpatient hospital

Per admission $200 per stay
Plan-listed inpatient copay $200
02

Emergency transport

Ambulance

Ground · in-networkCost share not reported
Air · in-networkCost share not reported
03

Emergency services

Emergency room

$50 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-networkNot reported
Combined in + outNot reported
05

Skilled care at home

Home health

In-networkCost share not reported
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$118 / month
Consolidated C + DNot reported

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-network$10 copay
Out-of-networkNot separately reported

Specialist

In-network$10 copay
Out-of-networkNot separately reported

Preventive care

In-networkCost share not reported
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-networkCost share not reported
Out-of-networkNot separately reported

Laboratory services

In-networkCost share not reported
Out-of-networkNot separately reported

X-rays & standard imaging

In-networkCost share not reported
Out-of-networkNot separately reported

MRI, CT & PET imaging

In-networkCost share not reported
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$50 copay
Out-of-networkNot separately reported

Ground ambulance

In-networkCost share not reported
Out-of-networkNot separately reported

Air ambulance

In-networkCost share not reported
Out-of-networkNot separately reported

Outpatient hospital

In-networkCost share not reported
Out-of-networkNot separately reported

Outpatient surgery / ASC

In-networkCost share not reported
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

In-networkCost share not reported
Out-of-networkNot separately reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-networkCost share not reported
Out-of-networkNot separately reported

Occupational therapy

In-networkCost share not reported
Out-of-networkNot separately reported

Physical & speech therapy

In-networkCost share not reported
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

In-networkCost share not reported
Out-of-networkNot separately reported

Substance use treatment

In-networkCost share not reported
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

In-network$10 copay
Out-of-networkNot separately reported

Chiropractic

In-networkCost share not reported
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

In-networkCost share not reported
Out-of-networkNot separately reported

Vision

In-networkCost share not reported
Out-of-networkNot separately reported

Hearing

In-networkCost share not reported
Out-of-networkNot separately reported

Transportation

In-networkCost share not reported
Out-of-networkNot separately reported

Fitness & wellness

Not reported in this CMS export

Not reported in this CMS export

Over-the-counter allowance

In-networkCost share not reported
Out-of-networkNot separately reported

Meals

Not reported in this CMS export

Not reported in this CMS export

Plan costs & rulesCoverage overview

Premium & Part B giveback

$118 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-networkNot reported
Combined in + outNot reported

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

1876 Cost · Referrals: Not required · Out-of-network coverage: No

Prescription drugs0 tiers

Part D deductible

CMS did not publish a supported Part D deductible amount

Using this plan

Understand H5264-005-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

DeanCare Gold Shared Value (Cost) is a 2026 1876 Cost offered by Dean Health Plan, Inc. in Select counties in south central WI. The CMS record does not indicate routine out-of-network coverage. The plan record does not require referrals. Its listed inpatient copay stages total $200 across null charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
$10 copay
Specialist
$10 copay
Laboratory services
Cost share not reported

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
Cost share not reported
MRI, CT & PET imaging
Cost share not reported
Outpatient hospital
Cost share not reported

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$50 copay
Listed inpatient stages
$200 total

null charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Select counties in south central WI (WI)
Plan type
1876 Cost
Contract / plan
H5264-005
Coverage year
2026

Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

DentalCost share not reported
VisionCost share not reported
HearingCost share not reported
Over-the-counter allowanceCost share not reported
TransportationCost share not reported

Plan-specific answers

Frequently asked questions

Where is H5264-005-000 available?

DeanCare Gold Shared Value (Cost) is listed for Select counties in south central WI (WI). Enrollment generally requires Medicare eligibility and residence in the plan's service area.

What is the monthly plan premium for H5264-005-000?

The listed Part C premium is $118 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H5264-005-000?

The plan record lists $50 copay, waived when an admission meets the plan's stated timing rule.

Does H5264-005-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, over-the-counter allowance, transportation. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H5264-005-000 fits

Full CMS plan ID
H5264-005-000
Contract
H5264
Base plan code
H5264-005
Segment
000
Carrier
Dean Health Plan, Inc.
Plan type
1876 Cost
Service area
Select counties in south central WI (WI)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • Columbia, WI
  • Dane, WI
  • Dodge, WI
  • Grant, WI
  • Iowa, WI
  • Jefferson, WI
  • Rock, WI
  • Sauk, WI

Same CMS contract

H5264-002-000 DeanCare Gold Enhanced (Cost) Select counties in south central WI · 1876 Cost

About this code

What H5264-005-000 identifies

H5264-005-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H5264-005, H5264 005, or the compact full CMS ID H5264005000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.