2022 Wellcare Patriot No Premium Open (PPO)

Wellcare Patriot No Premium Open (PPO) H7175-005 is a 2022 Medicare Advantage Plan or Part-C by Wellcare available to residents in North Carolina. 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 $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 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 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 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

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

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	50% coinsurance (Out-of-Network)
Diagnostic services	$0 copay
Endodontics	50% coinsurance (Out-of-Network)
Endodontics	$0 copay
Extractions	$0 copay
Extractions	50% coinsurance (Out-of-Network)
Non-routine services	50% coinsurance (Out-of-Network)
Non-routine services	$0 copay
Periodontics	$0 copay
Periodontics	50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Restorative services	$0 copay
Restorative services	50% coinsurance (Out-of-Network)

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$0-100 copay
Diagnostic radiology services (e.g., MRI)	$0-250 copay (Out-of-Network)
Diagnostic tests and procedures	$0-250 copay (Out-of-Network)
Diagnostic tests and procedures	$0-25 copay
Lab services	$0 copay
Lab services	$0 copay (Out-of-Network)
Outpatient x-rays	$0 copay
Outpatient x-rays	$0 copay (Out-of-Network)

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Doctor Visits

Primary	$0 copay (Out-of-Network)
Primary	$0 copay
Specialist	$0-250 copay per visit (Out-of-Network)
Specialist	$30 copay per visit

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Emergency care/Urgent Care

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

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Foot Care (podiatry services)

Foot exams and treatment	$30 copay
Foot exams and treatment	$0-250 copay (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$250 copay
$0-250 copay (Out-of-Network)

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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	$0-250 copay (Out-of-Network)
Hearing exam	$30 copay

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Inpatient Hospital Coverage

35% per day for days 1 through 90 (Out-of-Network)
$300 per day for days 1 through 6 $0 per day for days 7 through 90

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Medical Equipment/Supplies

Diabetes supplies	$0 copay or 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)

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Medicare Part B Drugs

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

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Mental Health Services

Inpatient hospital - psychiatric	35% per day for days 1 through 90 (Out-of-Network)
Inpatient hospital - psychiatric	$350 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	$0-250 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$0-250 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	$0-250 copay (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	$0-250 copay (Out-of-Network)

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MOOP

$10,000 In and Out-of-network $5,500 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$100-250 copay per visit
$0-250 copay per visit (Out-of-Network)

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Preventive Care

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

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Preventive Dental

Cleaning	$0 copay
Cleaning	50% coinsurance (Out-of-Network)
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	$0 copay
Oral exam	50% coinsurance (Out-of-Network)

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Rehabilitation Services

Occupational therapy visit	$0-250 copay (Out-of-Network)
Occupational therapy visit	$30 copay
Physical therapy and speech and language therapy visit	$30 copay
Physical therapy and speech and language therapy visit	$0-250 copay (Out-of-Network)

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Skilled Nursing Facility

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

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Transportation

Not covered

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Vision

Contact lenses	40% coinsurance (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass frames	40% coinsurance (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglass lenses	40% coinsurance (Out-of-Network)
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)

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Wellcare Patriot No Premium Open (PPO) H7175

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Wellcare Patriot No Premium Open (PPO) Plans Performance

Health Plan Customer Service Rating for Wellcare Patriot No Premium Open (PPO)

Wellcare Patriot No Premium Open (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

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.