2022 Wellcare Assist Open (PPO)
Wellcare Assist Open (PPO) H1914-004 is a 2022 Medicare Advantage Plan or Part-C by Wellcare available to residents in Connecticut. This plan includes additional prescription drug (Part-D) coverage. The Wellcare Assist Open (PPO) has a monthly premium of $27.20 and has an in-network maximum out-of-pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out-of-pocket. This can be a extremely nice safety net.
Wellcare Assist Open (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 Assist Open (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 you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Wellcare except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.
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2022 Wellcare Medicare Advantage Plan Costs
Wellcare Assist Open (PPO)
|Monthly Premium C+D:||$27.20|
|Part C Premium:||$0.00|
|Part D (Drug) Premium:||$27.20|
|Part D Supplemental Premium||$0.00|
|Total Part D Premium:||$27.20|
|Tiers with No Deductible:||1|
|Benchmark:||not below the regional benchmark|
|Type of Medicare Health:||Enhanced Alternative|
|Drug Benefit Type:||Enhanced|
|New Plan:||2023 H1914-001|
Wellcare Assist Open (PPO) Part-C Premium
Wellcare 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.
H1914-004 Part-D Deductible and Premium
Wellcare Assist Open (PPO) has a monthly drug premium of $27.20 and a $480.00 drug deductible. This Wellcare plan offers a $27.20 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 $27.20 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.
Wellcare Gap Coverage
In 2022 once you and your plan provider have spent $4430 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 not offer additional coverage through the gap.
The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Wellcare Assist Open (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.80 for 75% low income subsidy $13.60 for 50% and $20.40 for 25%.
|Full LIS Premium:||$0.00|
|75% LIS Premium:||$6.80|
|50% LIS Premium:||$13.60|
|25% LIS Premium:||$20.40|
H1914-004 Formulary or Drug Coverage
Wellcare Assist Open (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Wellcare Assist Open (PPO) H1914-004 Formulary here.
CMS Star Ratings for Wellcare Assist Open (PPO) H1914
|2021 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|
|Monitoring Physical Activity|
Managing Chronic And Long Term Care for Older Adults
|SNP Care Management|
|Functional Status Assessment|
|Diabetes Care - Eye Exam|
|Diabetes Care - Kidney Disease|
|Diabetes Care - Blood Sugar|
|Reducing Risk of Falling|
|Improving Bladder Control|
Member Experience with Health Plan
|Total Experience Rating|
|Getting Needed Care|
|Health Care Quality|
|Rating of Health Plan|
Member Complaints and Changes in Wellcare Assist Open (PPO) Plans Performance
|Complaints about Health Plan|
|Members Leaving the Plan|
|Health Plan Quality Improvement|
Health Plan Customer Service Rating for Wellcare Assist Open (PPO)
|Total Customer Service Rating|
|Timely Decisions About Appeals|
|Reviewing Appeals Decisions|
|Call Center, TTY, Foreign Language|
Wellcare Assist Open (PPO) Drug Plan Customer Service Ratings
|Call Center, TTY, Foreign Language|
Ratings For Member Complaints and Changes in the Drug Plans Performance
|Complaints about the Drug Plan|
|Members Choosing to Leave the Plan|
|Drug Plan Quality Improvement|
Member Experience with the Drug Plan
|Rating of Drug Plan|
|Getting Needed Prescription Drugs|
Drug Safety and Accuracy of Drug Pricing
|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|
Ready to Enroll?
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Wellcare Assist Open (PPO)
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Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.