2022 Wellcare Plus Open (PPO)


Wellcare Plus Open (PPO) H6594-003 is a 2022 Medicare Advantage Plan or Part-C by Wellcare available to residents in Vermont. This plan includes additional prescription drug (Part-D) coverage. The Wellcare Plus Open (PPO) has a monthly premium of $25.10 and has an in-network maximum out-of-pocket limit of $3,450 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,450 out-of-pocket. This can be a extremely nice safety net.

Wellcare Plus 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 Plus 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 Plus Open (PPO)
Plan ID:
H6594-003
Provider:Wellcare
Year:2022
Type: Local PPO
Monthly Premium C+D: $25.10
Part C Premium:$0.00
MOOP: $3,450
Part D (Drug) Premium:$25.10
Part D Supplemental Premium$0.00
Total Part D Premium:$25.10
Drug Deductible:$480.00
Tiers with No Deductible:1
Gap Coverage:No
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H6594-004
New Plan: 2023 H6594-004




Wellcare Plus 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.



H6594-003 Part-D Deductible and Premium

Wellcare Plus Open (PPO) has a monthly drug premium of $25.10 and a $480.00 drug deductible. This Wellcare plan offers a $25.10 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 $25.10 . 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.



Premium Assistance

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 Plus Open (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.30 for 75% low income subsidy $12.50 for 50% and $18.80 for 25%.



Full LIS Premium:$0.00
75% LIS Premium:$6.30
50% LIS Premium:$12.50
25% LIS Premium:$18.80


H6594-003 Formulary or Drug Coverage

Wellcare Plus 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 Plus Open (PPO) H6594-003 Formulary here.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA $0
Tier 2 NA $4
Tier 3 NA $47
Tier 4 NA 48%
Tier 5 NA 25%
Tier 6 NA $0
*Initial Coverage Phase and 30 day supply





2021 Wellcare Plus 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 50% coinsurance (Out-of-Network)
Endodontics $0 copay
Endodontics 50% coinsurance (Out-of-Network)
Extractions $0 copay
Extractions 50% coinsurance (Out-of-Network)
Non-routine services $0 copay
Non-routine services 50% coinsurance (Out-of-Network)
Periodontics $0 copay
Periodontics 50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services 50% coinsurance (Out-of-Network)
Restorative services $0 copay
Restorative services 50% coinsurance (Out-of-Network)



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $0 copay or 20% coinsurance
Diagnostic radiology services (e.g., MRI) 30% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0 copay or 20% coinsurance
Diagnostic tests and procedures 30% coinsurance (Out-of-Network)
Lab services $0 copay
Lab services 30% coinsurance (Out-of-Network)
Outpatient x-rays $0 copay
Outpatient x-rays 30% coinsurance (Out-of-Network)



Doctor Visits


Primary $30 copay per visit (Out-of-Network)
Primary 20% coinsurance per visit
Specialist $50 copay per visit (Out-of-Network)
Specialist 20% coinsurance per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $50 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $50 copay (Out-of-Network)
Foot exams and treatment 20% coinsurance
Routine foot care Not covered



Ground Ambulance


20% coinsurance
20% coinsurance (Out-of-Network)



Hearing


Fitting/evaluation $0 copay
Fitting/evaluation 40% coinsurance (Out-of-Network)
Hearing aids $0 copay
Hearing aids 40% coinsurance (Out-of-Network)
Hearing exam $50 copay (Out-of-Network)
Hearing exam 20% coinsurance



Inpatient Hospital Coverage


$1,100 per day for days 1 through 2
$0 per day for days 3 through 90
$500 per day for days 1 through 7
$0 per day for days 8 through 90 (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies 20% coinsurance per item
Diabetes supplies 20% coinsurance per item (Out-of-Network)
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 30% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance
Other Part B drugs 30% coinsurance (Out-of-Network)



Mental Health Services


Inpatient hospital - psychiatric $370 per day for days 1 through 4
$0 per day for days 5 through 90
Inpatient hospital - psychiatric $500 per day for days 1 through 7
$0 per day for days 8 through 90 (Out-of-Network)
Outpatient group therapy visit $40 copay
Outpatient group therapy visit 30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient group therapy visit with a psychiatrist 30% coinsurance (Out-of-Network)
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit 30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit with a psychiatrist 30% coinsurance (Out-of-Network)



MOOP


$5,150 In and Out-of-network
$3,450 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


20% coinsurance per visit
30% coinsurance per visit (Out-of-Network)



Preventive Care


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



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit 20% coinsurance
Occupational therapy visit 30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit 20% coinsurance
Physical therapy and speech and language therapy visit 30% coinsurance (Out-of-Network)



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)



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





Ready to Enroll?

Click Here

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




Coverage Area for Wellcare Plus 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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