2017 Medicare Advantage WellCare Advance (HMO)
WellCare Advance (HMO) H1416-027 is a 2017 Medicare Advantage or Medicare Part-C plan by WellCare available to residents in Arkansas Mississippi South Carolina Tennessee. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The WellCare Advance (HMO) has a monthly premium of $0.00 and has a in-network Maximum Out-of-Pocket limit of $4,500 (MOOP). This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket $4,500 this can be a very nice safety net.
WellCare Advance (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.
WellCare works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for WellCare Advance (HMO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from WellCare and not Original Medicare. With Medicare Advantage your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from WellCare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
2017 WellCare Medicare Advantage Plan Details
| Name: | WellCare Advance (HMO) |
|---|---|
| ID: | H1416-027 |
| Provider: | WellCare |
| Year: | 2017 |
| Type: | Local HMO * |
| Monthly Premium C+D: | $0.00 |
| MOOP: | $4,500 |
Ratings for WellCare Advance (HMO) H1416
| 2017 Overall Rating | ||
|---|---|---|
| Part C Summary Rating | ||
| Part D Summary Rating | ||
| Staying Healthy: Screenings, Tests, Vaccines | ||
| Managing Chronic (Long Term) Conditions | ||
| Member Experience with Health Plan | ||
| Complaints and Changes in Plans Performance | ||
| Health Plan Customer Service | ||
| Drug Plan Customer Service | ||
| Complaints and Changes in the Drug Plan | ||
| Member Experience with the Drug Plan | ||
| Drug Safety and Accuracy of Drug Pricing |
Member Experience with Health Plan
| Total Experience Rating | ||
|---|---|---|
| Getting Needed Care | ||
| Timely Care and Appointments | ||
| Customer Service | ||
| Health Care Quality | ||
| Rating of Health Plan | ||
| Care Coordination |
Member Complaints and Changes in WellCare Advance (HMO) Plans Performance
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Beneficiary Access | ||
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for WellCare Advance (HMO)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center, TTY, Foreign Language |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | ||
|---|---|---|
| Breast Cancer Screening | ||
| Colorectal Cancel Screening | ||
| Annual Flu Vaccine | ||
| Improving Physical | ||
| Improving Mental Health | ||
| Monitoring Physical Activity | ||
| Adult BMI Assessment |
Managing Chronic And Long Term Care for Older Adults
| Total Rating | ||
|---|---|---|
| SNP Care Management | ||
| Medication Review | ||
| Functional Status Assessment | ||
| Pain Screening | ||
| Osteoporosis Management | ||
| Diabetes Care - Eye Exam | ||
| Diabetes Care - Kidney Disease | ||
| Diabetes Care - Blood Sugar | ||
| Controlling Blood Pressure | ||
| Rheumatoid Arthritis | ||
| Improving Bladder Control | ||
| Reducing Risk of Falling | ||
| Plan - Cause Readmissions |
Member Experience with the Drug Plan
| Total Rating | ||
|---|---|---|
| Rating of Drug Plan | ||
| Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
| Total Rating | ||
|---|---|---|
| MPF Price Accuracy | ||
| High Risk Medication | ||
| Drug Adherence for Diabetes Medications | ||
| Drug Adherence for Hypertension (RAS antagonists) | ||
| Drug Adherence for Cholesterol (Statins) | ||
| MTM Program Completion Rate for CMR |
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating | ||
|---|---|---|
| Complaints about the Drug Plan | ||
| Members Choosing to Leave the Plan | ||
| Beneficiary Access | ||
| Drug Plan Quality Improvement |
WellCare Advance (HMO) Drug Plan Customer Service ratings
| Total Rating | ||
|---|---|---|
| Appeals Auto Forward | ||
| Appeals Upheld | ||
| Call Center, TTY, Foreign Language |
Coverage Area for WellCare Advance (HMO)
(Click county to compare all available plans)
Source: CMS.
Data as of September 6, 2016
Star Rating as of September 26, 2016.
For More Information on Ratings Please See the CMS Tech Notes Here.
Notes: Data are subject to change as contracts are finalized. For 2017, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit
Includes 2017 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
