2022 Wellcare Endurance Open (PPO)


Wellcare Endurance Open (PPO) H0111-005 is a 2022 Medicare Advantage Plan or Part-C by Wellcare available to residents in Georgia. This plan includes additional prescription drug (Part-D) coverage. The Wellcare Endurance Open (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,500 out-of-pocket. This can be a extremely nice safety net.

Wellcare Endurance 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 Endurance 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

Name:
Wellcare Endurance Open (PPO)
Plan ID:
H0111-005
Provider:Wellcare
Year:2022
Type: Local PPO
Monthly Premium C+D: $0
Part C Premium:$0.00
MOOP: $5,500
Part D (Drug) Premium:$0.00
Part D Supplemental Premium$0.00
Total Part D Premium:$0.00
Drug Deductible:$0.00
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H0111-001




Wellcare Endurance 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.



H0111-005 Part-D Deductible and Premium

Wellcare Endurance Open (PPO) has a monthly drug premium of $0.00 and a $0.00 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 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 offer additional coverage through the gap.



H0111-005 Formulary or Drug Coverage

Wellcare Endurance 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 Endurance Open (PPO) H0111-005 Formulary here.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 $0 $0
Tier 2 $0 $5
Tier 3 $30 $40
Tier 4 $90 $100
Tier 5 33% 33%
Tier 6 $0 $0
*Initial Coverage Phase and 30 day supply





2021 Wellcare Endurance Open (PPO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


Diagnostic services Not covered
Endodontics Not covered
Extractions Not covered
Non-routine services $0 copay
Non-routine services 50% coinsurance (Out-of-Network)
Periodontics 50% coinsurance (Out-of-Network)
Periodontics $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services Not covered
Restorative services Not covered



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) 20% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI) $0-300 copay
Diagnostic tests and procedures 20% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0-100 copay
Lab services 20% coinsurance (Out-of-Network)
Lab services $0 copay
Outpatient x-rays 20% coinsurance (Out-of-Network)
Outpatient x-rays $0 copay



Doctor Visits


Primary $0 copay
Primary 20% coinsurance per visit (Out-of-Network)
Specialist $35 copay per visit
Specialist 20% coinsurance per visit (Out-of-Network)



Emergency care/Urgent Care


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



Foot Care (podiatry services)


Foot exams and treatment $35 copay
Foot exams and treatment 20% coinsurance (Out-of-Network)
Routine foot care 20% coinsurance (Out-of-Network)
Routine foot care $35 copay



Ground Ambulance


$265 copay
$265 copay (Out-of-Network)



Hearing


Fitting/evaluation 40% coinsurance (Out-of-Network)
Fitting/evaluation $0 copay
Hearing aids $0 copay
Hearing aids 40% coinsurance (Out-of-Network)
Hearing exam 20% coinsurance (Out-of-Network)
Hearing exam $35 copay



Inpatient Hospital Coverage


$350 per day for days 1 through 5
$0 per day for days 6 through 90
20% per day for days 1 through 90 (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies 20% coinsurance per item (Out-of-Network)
Diabetes supplies $0 copay per item
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Chemotherapy 20% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance
Other Part B drugs 20% coinsurance (Out-of-Network)



Mental Health Services


Inpatient hospital - psychiatric 20% per day for days 1 through 90 (Out-of-Network)
Inpatient hospital - psychiatric $1,871 per stay
Outpatient group therapy visit $40 copay
Outpatient group therapy visit 20% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist 20% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit 20% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist 20% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay



MOOP


$10,000 In and Out-of-network
$4,900 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


20% coinsurance per visit (Out-of-Network)
$300-325 copay per visit



Preventive Care


$0 copay (Out-of-Network)
$0 copay



Preventive Dental


Cleaning 50% coinsurance (Out-of-Network)
Cleaning $0 copay
Dental x-ray(s) 50% coinsurance (Out-of-Network)
Dental x-ray(s) $0 copay
Fluoride treatment $0 copay
Fluoride treatment 50% coinsurance (Out-of-Network)
Oral exam 50% coinsurance (Out-of-Network)
Oral exam $0 copay



Rehabilitation Services


Occupational therapy visit 20% coinsurance (Out-of-Network)
Occupational therapy visit $40 copay
Physical therapy and speech and language therapy visit 20% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit $40 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100
20% per day for days 1 through 100 (Out-of-Network)



Transportation


$0 copay
75% coinsurance (Out-of-Network)



Vision


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



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for Wellcare Endurance Open (PPO) H0111



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

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
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
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Wellcare Endurance Open (PPO) Plans Performance

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


Health Plan Customer Service Rating for Wellcare Endurance Open (PPO)

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


Wellcare Endurance Open (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


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



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Or Call
1-855-778-4180
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Sun 9am-6pm EST




Coverage Area for Wellcare Endurance Open (PPO)

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State: Georgia
County:


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Source: CMS.
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.

*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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