2018 WellCare Advance (HMO-POS) H1416-027 By WellCare

2018 Medicare Advantage WellCare Advance (HMO-POS)

WellCare Advance (HMO-POS) H1416-027 is a 2018 Medicare Advantage or Medicare Part-C plan by WellCare available to residents in South Carolina Mississippi Tennessee Arkansas. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The WellCare Advance (HMO-POS) 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-POS) 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-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and 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.



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2018 WellCare Medicare Advantage Plan Details

Name:
WellCare Advance (HMO-POS)
ID:
H1416-027
Provider:WellCare
Year:2018
Type: Local HMO *
Monthly Premium C+D: $0.00
MOOP: $4,500




Plan Services






Health plan deductible


$0



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures In-Network $0-50
Diagnostic tests and procedures Out-of-Network 20%
Lab services In-Network $0 copay
Lab services Out-of-Network 20%
Diagnostic radiology services (e.g., MRI) In-Network $100-150
Diagnostic radiology services (e.g., MRI) Out-of-Network 20%
Outpatient x-rays In-Network $0
Outpatient x-rays Out-of-Network 20%



Hearing


Hearing exam In-Network $35
Hearing exam Out-of-Network 20%
Fitting/evaluation In-Network $0 copay
Hearing aids In-Network $0 copay



Preventive dental


Oral exam In-Network $0 copay
Cleaning In-Network $0 copay
Fluoride treatment In-Network $0 copay
Dental x-ray(s) In-Network $0 copay



Comprehensive dental


Non-routine services Not covered
Diagnostic services In-Network $0 copay
Restorative services In-Network $0 copay
Endodontics In-Network $0 copay
Periodontics In-Network $0 copay
Extractions In-Network $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services In-Network $0 copay



Vision


Routine eye exam In-Network $0 copay
Other Not covered
Contact lenses In-Network $0 copay
Eyeglasses (frames and lenses) In-Network $0 copay
Eyeglass frames In-Network $0 copay
Eyeglass lenses In-Network $0 copay
Upgrades Not covered



Mental health services


In-Network $325 for days 1 through 4
$0 for days 5 through 90
Out-of-Network 20% per stay
Outpatient group therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit with a psychiatrist Out-of-Network 20%
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient individual therapy visit with a psychiatrist Out-of-Network 20%
Outpatient group therapy visit In-Network $40
Outpatient group therapy visit Out-of-Network 20%
Outpatient individual therapy visit In-Network $40
Outpatient individual therapy visit Out-of-Network 20%



Skilled Nursing Facility


In-Network $0 for days 1 through 20
$164.50 for days 21 through 100
Out-of-Network 20% per stay



Rehabilitation services


Occupational therapy visit In-Network $35
Occupational therapy visit Out-of-Network 20%
Physical therapy and speech and language therapy visit In-Network $35
Physical therapy and speech and language therapy visit Out-of-Network 20%



Ambulance


In-Network $200
Out-of-Network 20%



Transportation


In-Network $0 copay



Other health plan deductibles?


In-Network No



Foot care (podiatry services)


Foot exams and treatment In-Network $35
Foot exams and treatment Out-of-Network 20%
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 20% per item
Diabetes supplies In-Network 20% per item
Diabetes supplies Out-of-Network 20% per item



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy In-Network 20%
Chemotherapy Out-of-Network 20%
Other Part B drugs In-Network 20%
Other Part B drugs Out-of-Network 20%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$4,500 In and Out-of-network
$4,500 In-network
$4,500 Out-of-network



Optional supplemental benefits


No



Inpatient hospital coverage


In-Network $325 for days 1 through 5
$0 for days 6 through 90
Out-of-Network 20% per stay



Outpatient hospital coverage


In-Network $150 per visit
Out-of-Network 20% per visit



Doctor visits


Primary In-Network $5 per visit
Primary Out-of-Network 20% per visit
Specialist In-Network $35 per visit
Specialist Out-of-Network 20% per visit



Preventive care


In-Network $0 copay
Out-of-Network 20%



Emergency care/Urgent care


Emergency $80 per visit (always covered)
Urgent care $35 per visit (always covered)






Ratings for WellCare Advance (HMO-POS) H1416

2018 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-POS) 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-POS)

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 Cancer 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
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-POS) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld
Call Center, TTY, Foreign Language


Coverage Area for WellCare Advance (HMO-POS)

(Click county to compare all available plans)

State:South Carolina
Mississippi
Tennessee
Arkansas
County:Abbeville, Adams, Anderson, Arkansas,
Ashley, Attala, Baxter,
Bedford, Benton, Bledsoe,
Blount, Bolivar, Bradley,
Bradley, Calhoun, Campbell,
Cannon, Carroll, Carroll,
Carroll, Carter, Cheatham,
Cherokee, Chester, Chicot,
Claiborne, Claiborne, Clark,
Clarke, Clay, Cleburne,
Cleveland, Coahoma, Cocke,
Coffee, Conway, Copiah,
Covington, Craighead, Crittenden,
Crockett, Cross, Dallas,
Davidson, Decatur, Desha,
DeSoto, Dyer, Fayette,
Forrest, Franklin, Fulton,
Garland, Giles, Grainger,
Grant, Greene, Greene,
Greenville, Greenwood, Grenada,
Grundy, Hamblen, Hamilton,
Hancock, Hardeman, Hardin,
Hawkins, Haywood, Henderson,
Henry, Hickman, Hinds,
Holmes, Hot Spring, Houston,
Humphreys, Humphreys, Independence,
Issaquena, Izard, Jackson,
Jasper, Jefferson, Jefferson,
Jefferson Davis, Johnson, Jones,
Kemper, Knox, Lafayette,
Lake, Lamar, Lauderdale,
Lauderdale, Lawrence, Lawrence,
Lawrence, Leake, Lee,
Lewis, Lincoln, Lincoln,
Lonoke, Loudon, Macon,
Madison, Madison, Marion,
Marion, Marion, Marshall,
Marshall, Maury, McCormick,
McMinn, McNairy, Meigs,
Mississippi, Monroe, Monroe,
Montgomery, Montgomery, Moore,
Morgan, Neshoba, Nevada,
Newberry, Newton, Newton,
Obion, Ouachita, Panola,
Perry, Perry, Phillips,
Pickens, Pike, Pike,
Poinsett, Polk, Prairie,
Pulaski, Quitman, Randolph,
Rankin, Rhea, Roane,
Robertson, Rutherford, Saline,
Saluda, Scott, Scott,
Searcy, Sequatchie, Sevier,
Sharkey, Sharp, Shelby,
Simpson, Smith, Spartanburg,
St. Francis, Stewart, Stone,
Sullivan, Sumner, Sunflower,
Tallahatchie, Tate, Tipton,
Trousdale, Tunica, Unicoi,
Union, Union, Union,
Van Buren, Walthall, Warren,
Washington, Washington, Wayne,
Wayne, Weakley, White,
Williamson, Wilson, Woodruff,
Yazoo, Yell,


Source: CMS.

Data as of September 5, 2017

Star Rating as of September 6, 2017.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change as contracts are finalized. For 2018, 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 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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