2022 Wellcare Patriot No Premium (HMO)


Wellcare Patriot No Premium (HMO) H2134-006 is a 2022 Medicare Advantage Plan or Part-C by Wellcare by Allwell available to residents in New Mexico. This plan does not provide additional prescription drug (Part-D) coverage. The Wellcare Patriot No Premium (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,400 out-of-pocket. This can be a extremely nice safety net.

Wellcare Patriot No Premium (HMO) 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 require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

Wellcare by Allwell works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Wellcare Patriot No Premium (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Wellcare by Allwell 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 by Allwell except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.




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1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST




2022 Wellcare by Allwell Medicare Advantage Plan Costs

Name:
Wellcare Patriot No Premium (HMO)
Plan ID:
H2134-006
Provider:Wellcare by Allwell
Year:2022
Type: Local HMO *
Monthly Premium C+D: $0
Part C Premium:
MOOP: $4,400
Similar Plan: H2134-002
New Plan: 2023 H2134-002




2021 Wellcare Patriot No Premium (HMO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


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



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) 20% coinsurance
Diagnostic tests and procedures $0 copay
Lab services $0 copay
Outpatient x-rays $10 copay



Doctor Visits


Primary $0 copay
Specialist $35 copay per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $45 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $35 copay
Routine foot care Not covered



Ground Ambulance


$295 copay



Hearing


Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered
Hearing exam $35 copay



Inpatient Hospital Coverage


$250 per day for days 1 through 5
$0 per day for days 6 through 90



Medical Equipment/Supplies


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



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $250 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit $30 copay
Outpatient group therapy visit with a psychiatrist $30 copay
Outpatient individual therapy visit $30 copay
Outpatient individual therapy visit with a psychiatrist $30 copay



MOOP


$4,400 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$250 copay per visit



Preventive Care


$0 copay



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit $0 copay
Physical therapy and speech and language therapy visit $0 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100



Transportation


$0 copay



Vision


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



Wellness Programs (e.g. fitness nursing hotline)


Covered





Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST




Coverage Area for Wellcare Patriot No Premium (HMO)

(Click county to compare all available Advantage plans)



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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.

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Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.