2022 Wellcare Patriot No Premium Open (PPO)


Wellcare Patriot No Premium Open (PPO) H5439-010 is a 2022 Medicare Advantage Plan or Part-C by Wellcare by Health Net available to residents in Oregon and Washington. This plan does not provide additional prescription drug (Part-D) coverage. The Wellcare Patriot No Premium Open (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $2,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $2,500 out-of-pocket. This can be a extremely nice safety net.

Wellcare Patriot No Premium 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 by Health Net 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 Open (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Wellcare by Health Net 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 Health Net 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 by Health Net Medicare Advantage Plan Costs

Name:
Wellcare Patriot No Premium Open (PPO)
Plan ID:
H5439-010
Provider:Wellcare by Health Net
Year:2022
Type: Local PPO *
Monthly Premium C+D: $0
Part C Premium:
MOOP: $2,500
Similar Plan: H5439-011
New Plan: 2023 H5439-011




2021 Wellcare Patriot No Premium Open (PPO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


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



Deductible


$125 annual deductible



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) 20% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI) 15% coinsurance
Diagnostic tests and procedures 0-15% coinsurance
Diagnostic tests and procedures 0-20% coinsurance (Out-of-Network)
Lab services $0 copay
Lab services $0 copay (Out-of-Network)
Outpatient x-rays $12 copay
Outpatient x-rays $20 copay (Out-of-Network)



Doctor Visits


Primary $12 copay per visit
Primary $20 copay per visit (Out-of-Network)
Specialist $40 copay per visit (Out-of-Network)
Specialist $25 copay per visit



Emergency care/Urgent Care


Emergency $120 copay per visit (always covered)
Urgent care $25 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $40 copay (Out-of-Network)
Foot exams and treatment $25 copay
Routine foot care Not covered



Ground Ambulance


$100 copay
$100 copay (Out-of-Network)



Hearing


Fitting/evaluation $0 copay
Fitting/evaluation $0 copay (Out-of-Network)
Hearing aids $0-1,580 copay
Hearing aids $0-1,580 copay (Out-of-Network)
Hearing exam $25 copay
Hearing exam $40 copay (Out-of-Network)



Inpatient Hospital Coverage


$175 per day for days 1 through 8
$0 per day for days 9 through 90
$200 per day for days 1 through 8
$0 per day for days 9 and beyond (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies 0-20% coinsurance per item (Out-of-Network)
Diabetes supplies $0 copay
Durable medical equipment (e.g., wheelchairs, oxygen) 15% 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 (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs) 15% coinsurance per item



Medicare Part B Drugs


Chemotherapy 15% coinsurance
Chemotherapy 20% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance (Out-of-Network)
Other Part B drugs 15% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $200 per day for days 1 through 8
$0 per day for days 9 through 190 (Out-of-Network)
Inpatient hospital - psychiatric $175 per day for days 1 through 8
$0 per day for days 9 through 90
Outpatient group therapy visit $40 copay (Out-of-Network)
Outpatient group therapy visit $25 copay
Outpatient group therapy visit with a psychiatrist $25 copay
Outpatient group therapy visit with a psychiatrist $40 copay (Out-of-Network)
Outpatient individual therapy visit $25 copay
Outpatient individual therapy visit $40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $25 copay



MOOP


$5,100 In and Out-of-network
$2,500 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


20% coinsurance per visit
$200 copay per visit (Out-of-Network)



Preventive Care


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



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit $40 copay (Out-of-Network)
Occupational therapy visit $25 copay
Physical therapy and speech and language therapy visit $25 copay
Physical therapy and speech and language therapy visit $40 copay (Out-of-Network)



Skilled Nursing Facility


$0 per day for days 1 through 20
$220 per day for days 21 through 100 (Out-of-Network)
$0 per day for days 1 through 20
$184 per day for days 21 through 100



Transportation


Not covered



Vision


Contact lenses $0 copay
Contact lenses $0 copay (Out-of-Network)
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) $0 copay (Out-of-Network)
Eyeglasses (frames and lenses) $0 copay
Other Not covered
Routine eye exam $10 copay
Routine eye exam $10 copay (Out-of-Network)
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for Wellcare Patriot No Premium Open (PPO) H5439



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 Patriot No Premium 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 Patriot No Premium Open (PPO)

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


Wellcare Patriot No Premium 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



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 Open (PPO)

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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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