2020 WellCare Premier (PPO) H5199-012 By WellCare.

2020 Medicare Advantage Plan Services for
WellCare Premier (PPO)


WellCare Premier (PPO) H5199-012 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by WellCare available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The WellCare Premier (PPO) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,400 out of pocket. This can be a extremely nice safety net.

WellCare Premier (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

WellCare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for WellCare Premier (PPO) 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 Plans you are always covered for urgently needed and emergency care. Plus 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.





2020 WellCare Medicare Advantage Plan Details

Name:
WellCare Premier (PPO)
ID:
H5199-012
Provider:WellCare
Year:2020
Type: Local PPO
Monthly Premium C+D: $-
Part C Premium:$0.00
MOOP: $3,400
Part D (Drug) Premium:$0.00
Part D Supplemental Premium$0.00
Total Part D Premium:$0.00
Drug Deductible:$100.00
Tiers with No Deductible:1
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced




Part-C Premium

WellCare plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



Part-D Deductible and Premium

WellCare Premier (PPO) has a monthly drug premium of $0.00 and a $100.00 drug deductible. This WellCare plan offers a $0.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by WellCare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The WellCare Premier (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.



Full LIS Premium:$0.00
75% LIS Premium:$0.00
50% LIS Premium:$0.00
25% LIS Premium:$0.00


Gap Coverage

In 2020 once you and your plan provider have spent $4020 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This WellCare plan does offer additional coverage through the gap.



WellCare Drug Coverage and Formulary

A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 WellCare Premier (PPO) H5199-012 Formulary here.

Drug Tier Copay
Preferred
Copay
Nonpreferred
1 NA $0
2 NA $5
3 NA $47
4 NA $100
5 NA 31%
*Initial Coverage Phase and 30 day supply

See the 2020 WellCare Formulary





2019 Plan Services

(*2020 Plan services will be added when available)




Health plan deductible


$0



Emergency care/Urgent care


Emergency $90 per visit (always covered)
Urgent care $30 per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures Out-of-Network 40%
Diagnostic tests and procedures In-Network $0-100
Lab services Out-of-Network 40%
Lab services In-Network $0 copay
Diagnostic radiology services (e.g., MRI) Out-of-Network 40%
Diagnostic radiology services (e.g., MRI) In-Network $0-150
Outpatient x-rays Out-of-Network 40%
Outpatient x-rays In-Network $20



Hearing


Hearing exam Out-of-Network 40-50%
Hearing exam In-Network $35
Fitting/evaluation Out-of-Network 40-50%
Fitting/evaluation In-Network $0 copay
Hearing aids Out-of-Network 40-50%
Hearing aids In-Network $0 copay



Preventive dental


Oral exam Out-of-Network 20-70%
Oral exam In-Network $0 copay
Cleaning Out-of-Network 20-70%
Cleaning In-Network $0 copay
Fluoride treatment Out-of-Network 20-70%
Fluoride treatment In-Network $0 copay
Dental x-ray(s) Out-of-Network 20-70%
Dental x-ray(s) In-Network $0 copay



Comprehensive dental


Non-routine services Not covered
Diagnostic services Out-of-Network 20-70%
Diagnostic services In-Network $0
Restorative services Out-of-Network 20-70%
Restorative services In-Network 20-50%
Endodontics Out-of-Network 20-70%
Endodontics In-Network 50%
Periodontics Out-of-Network 20-70%
Periodontics In-Network 50%
Extractions Out-of-Network 20-70%
Extractions In-Network 20%
Prosthodontics, other oral/maxillofacial surgery, other services Out-of-Network 20-70%
Prosthodontics, other oral/maxillofacial surgery, other services In-Network 50%



Vision


Routine eye exam Out-of-Network $0 or 40-50%
Routine eye exam In-Network $0 copay
Other Not covered
Contact lenses Out-of-Network $0 or 40-50%
Contact lenses In-Network $0 copay
Eyeglasses (frames and lenses) Out-of-Network $0 or 40-50%
Eyeglasses (frames and lenses) In-Network $0 copay
Eyeglass frames Out-of-Network $0 or 40-50%
Eyeglass frames In-Network $0 copay
Eyeglass lenses Out-of-Network $0 or 40-50%
Eyeglass lenses In-Network $0 copay
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric Out-of-Network 40% per day for days 1 through 90
Inpatient hospital - psychiatric In-Network $300 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit with a psychiatrist Out-of-Network 40%
Outpatient group therapy visit with a psychiatrist In-Network $40
Outpatient individual therapy visit with a psychiatrist Out-of-Network 40%
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit Out-of-Network 40%
Outpatient group therapy visit In-Network $40
Outpatient individual therapy visit Out-of-Network 40%
Outpatient individual therapy visit In-Network $40



Skilled Nursing Facility


Out-of-Network 50% per day for days 1 through 100
In-Network $0 per day for days 1 through 20
$172 per day for days 21 through 100



Rehabilitation services


Occupational therapy visit Out-of-Network 40%
Occupational therapy visit In-Network $40
Physical therapy and speech and language therapy visit Out-of-Network 40%
Physical therapy and speech and language therapy visit In-Network $40



Ground ambulance


Out-of-Network 40%
In-Network $300



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment Out-of-Network 40%
Foot exams and treatment In-Network $35
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 40% per item
Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 40% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Diabetes supplies Out-of-Network 40% per item
Diabetes supplies In-Network 10% per item



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


Covered



Medicare Part B drugs


Chemotherapy Out-of-Network 40%
Chemotherapy In-Network 20%
Other Part B drugs Out-of-Network 40%
Other Part B drugs In-Network 20%



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


$10,000 In and Out-of-network
$6,000 In-network



Optional supplemental benefits


No



Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?


In-Network No



Inpatient hospital coverage


Out-of-Network 40% per day for days 1 through 150
In-Network $300 per day for days 1 through 5
$0 per day for days 6 through 90



Outpatient hospital coverage


Out-of-Network 40% per visit
In-Network $250 per visit



Doctor visits


Primary Out-of-Network 40% per visit
Primary In-Network $5 per visit
Specialist Out-of-Network 40% per visit
Specialist In-Network $35 per visit



Preventive care


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




Coverage Area for WellCare Premier (PPO)

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Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, 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 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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