2020 Allwell Dual Medicare (HMO D-SNP) BA-H7173

Allwell Dual Medicare (HMO D-SNP) By Allwell

Allwell Dual Medicare (HMO D-SNP) is a 2020 Medicare Advantage Special Needs Plan plan by Allwell. This plan from Allwell works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Allwell and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Allwell Dual Medicare (HMO D-SNP) BA-H7173 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.

2020 Medicare Special Needs Plan Details

Plan Name:
Allwell Dual Medicare (HMO D-SNP)
Plan ID:
Special Needs Type: Dual-Eligible
Provider: Allwell
Plan Year:2020
Plan Type: Local HMO
Monthly Premium C+D: $25.30

The Allwell Dual Medicare (HMO D-SNP) BA-H7173 is available to residents in Georgia, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Allwell Dual Medicare (HMO D-SNP) 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.

Part-C Premium

Allwell 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

The Allwell Dual Medicare (HMO D-SNP) plan has a monthly drug premium of $25.30 and a $345.00 drug deductible. This Allwell plan offers a $25.30 Part D Basic Premium that is 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 Allwell 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 $25.30. 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 Allwell Dual Medicare (HMO D-SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.30 for 75% low income subsidy $12.60 for 50% and $19.00 for 25%.

Part C Premium: $0.00
Part D (Drug) Premium: $25.30
Part D Supplemental Premium $0.00
Total Part D Premium: $25.30
Drug Deductible: $345.00
Tiers with No Deductible: 1
Benchmark: below the regional benchmark
Type of Medicare Health Plan: Basic Alternative
Drug Benefit Type: Basic
Full LIS Premium: $0.00
75% LIS Premium: $6.30
50% LIS Premium: $12.60
25% LIS Premium: $19.00
Gap Coverage: No

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 brand-name drugs and 25% on generic drugs unless your plan offers additional coverage. This Allwell plan does not offer additional coverage through the gap.

Allwell 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 Allwell Dual Medicare (HMO D-SNP) H7173-001 Formulary here.

Drug Tier Copay
1 NA $0
2 NA $7
3 NA $47
4 NA $100
5 NA 26%
6 NA $0
*Initial Coverage Phase and 30 day supply

See the 2020 Allwell Formulary

2019 Plan Services

(*2020 Plan services will be added when available)

Health plan deductible

Coming soon

Emergency care/Urgent care

Emergency 0% or 20% per visit (always covered)
Urgent care 0% or 20% per visit (always covered)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures 0% or 20%
Lab services $0 copay
Diagnostic radiology services (e.g., MRI) 0% or 20%
Outpatient x-rays 0% or 20%


Hearing exam 0% or 20%
Fitting/evaluation $0 copay
Hearing aids $0 copay

Preventive dental

Oral exam $0 copay
Cleaning $0 copay
Fluoride treatment Not covered
Dental x-ray(s) $0 copay

Comprehensive dental

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


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

Mental health services

Inpatient hospital - psychiatric Coming soon
Outpatient group therapy visit with a psychiatrist 0% or 20%
Outpatient individual therapy visit with a psychiatrist 0% or 20%
Outpatient group therapy visit 0% or 20%
Outpatient individual therapy visit 0% or 20%

Skilled Nursing Facility

Coming soon

Rehabilitation services

Occupational therapy visit 0% or 20%
Physical therapy and speech and language therapy visit 0% or 20%

Ground ambulance

0% or 20%

Other health plan deductibles?

In-Network No


$0 copay

Foot care (podiatry services)

Foot exams and treatment 0% or 20%
Routine foot care Not covered

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen) 0% or 20% per item
Prosthetics (e.g., braces, artificial limbs) 0% or 20% per item
Diabetes supplies 0% or 20% per item

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


Medicare Part B drugs

Chemotherapy 0% or 20%
Other Part B drugs 0% or 20%

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

$3,400 In-network

Optional supplemental benefits


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

In-Network No

Inpatient hospital coverage

Coming soon

Outpatient hospital coverage

0% or 20% per visit

Doctor visits

Primary $0 copay
Specialist $0 or $10 per visit

Preventive care

$0 copay

Ratings for Allwell Dual Medicare (HMO D-SNP) BA

2019 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

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
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Plan All-Cause Readmissions
Statin Therapy

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 Allwell Dual Medicare (HMO D-SNP) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement

Health Plan Customer Service Rating for Allwell Dual Medicare (HMO D-SNP)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Allwell Dual Medicare (HMO D-SNP) Drug Plan Customer Service ratings

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

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

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
Statin with Diabetes

Coverage Area for Allwell Dual Medicare (HMO D-SNP)

Source: CMS.

Plans as of September 4, 2019.

Star Rating as of October 11, 2019.

Plan Services are 2019 information as reference. 2020 information will be added when released.

Notes: Data are subject to change. All contracts for 2020 have not been finalized. For 2020, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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