2023 Wellcare Giveback Open (PPO)

Wellcare Giveback Open (PPO) H5439-015 is a 2023 Medicare Advantage Plan or Part-C by Wellcare by Health Net available to residents in Oregon and Washington. This plan includes additional prescription drug (Part-D) coverage. Wellcare by Health Net Wellcare Giveback Open (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $7,550 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $7,550 out-of-pocket. This can be an extremely nice safety net.

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 Giveback 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 2023 Medicare Advantage Plan 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 if you sign up for Medicare Advantage in Oregon or Medicare Advantage in Washington.




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2023 Wellcare by Health Net Medicare Advantage Plan Overview

Name:Wellcare Giveback Open (PPO)
Plan ID:H5439 015 0
Provider:Wellcare by Health Net
Year:2023
Type:Local PPO
Combined Premium (C+D):$0/mo
Part C Premium:$0/mo
MOOP:$7,550/yr
Part D (Drug) Premium:$0/mo
Part D Supplemental Premium$0/mo
Total Part D Premium:$0/mo
Drug Deductible:$200.00/yr
Tiers with No Deductible:1
Gap Coverage:Yes
Benchmark:Not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H5439-017




What type of plan is Wellcare Giveback Open (PPO)

Wellcare Giveback 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.



How much does Wellcare Giveback Open (PPO) cost?


Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Wellcare by Health Net charges a $0 consolidated premium. The Part C premium is $0 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Wellcare Giveback Open (PPO) has a monthly drug premium of $0 and a $200.00 drug deductible. This Wellcare by Health Net plan offers a $0 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. This Premium covers any enhanced plan benefits offered by Wellcare by Health Net 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. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.


Wellcare by Health Net Gap Coverage

In 2023 once you and your plan provider have spent $4660 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 by Health Net plan does offer additional coverage through the gap.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Wellcare Giveback Open (PPO) by Wellcare by Health Net MOOP is $7,550. Once you spend $7,550 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.



Formulary and Drug Coverage

Wellcare Giveback 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.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 $5 $15
Tier 2 $15 $20
Tier 3 $37 $47
Tier 4 $90 $100
Tier 5 29% 29%
Tier 6 $0 $0

The complete Wellcare Giveback Open (PPO) Formulary.
*Initial Coverage Phase and 30 day supply





Summary of Benefits

*2021 data this will be updated with 2023 data when available.

The benefit information provided is a summary of what Wellcare Giveback Open (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Wellcare by Health Net helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.




Additional Benefits


No



Comprehensive Dental


Diagnostic services Not covered
Endodontics Not covered
Extractions Not covered
Non-routine services Not covered
Periodontics Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered
Restorative services Not covered



Deductible


$200 annual deductible



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) 20% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI) 20% coinsurance
Diagnostic tests and procedures 0-20% coinsurance
Diagnostic tests and procedures 0-20% coinsurance (Out-of-Network)
Lab services $0-15 copay
Lab services $20 copay (Out-of-Network)
Outpatient x-rays $18 copay
Outpatient x-rays $20 copay (Out-of-Network)



Doctor Visits


Primary $20 copay per visit
Primary $30 copay per visit (Out-of-Network)
Specialist $50 copay per visit
Specialist $60 copay per visit (Out-of-Network)



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $35 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $40 copay
Foot exams and treatment $50 copay (Out-of-Network)
Routine foot care Not covered



Ground Ambulance


$380 copay (Out-of-Network)
$380 copay



Hearing


Fitting/evaluation $0 copay (Out-of-Network)
Fitting/evaluation $0 copay
Hearing aids $0-1,580 copay (Out-of-Network)
Hearing aids $0-1,580 copay
Hearing exam $30 copay
Hearing exam $50 copay (Out-of-Network)



Inpatient Hospital Coverage


$450 per day for days 1 through 4
$0 per day for days 5 through 90
$500 per day for days 1 through 10
$0 per day for days 11 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) 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 (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs) 19% coinsurance per item



Medicare Part B Drugs


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



Mental Health Services


Inpatient hospital - psychiatric $475 per day for days 1 through 10
$0 per day for days 11 through 190 (Out-of-Network)
Inpatient hospital - psychiatric $350 per day for days 1 through 4
$0 per day for days 5 through 90
Outpatient group therapy visit $40 copay
Outpatient group therapy visit $50 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient group therapy visit with a psychiatrist $50 copay (Out-of-Network)
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit $50 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit with a psychiatrist $50 copay (Out-of-Network)



MOOP


$7,550 In and Out-of-network
$7,550 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


20% coinsurance per visit
$500 copay per visit (Out-of-Network)



Preventive Care


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



Preventive Dental


Cleaning Not covered
Dental x-ray(s) Not covered
Fluoride treatment Not covered
Oral exam Not covered



Rehabilitation Services


Occupational therapy visit $50 copay (Out-of-Network)
Occupational therapy visit $40 copay
Physical therapy and speech and language therapy visit $50 copay (Out-of-Network)
Physical therapy and speech and language therapy visit $40 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$195 per day for days 21 through 100 (Out-of-Network)
$0 per day for days 1 through 20
$160 per day for days 21 through 100



Transportation


Not covered



Vision


Contact lenses 20% coinsurance (Out-of-Network)
Contact lenses $0 copay
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) 20% coinsurance (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




Wellcare Giveback Open (PPO) Reviews


Is Wellcare Giveback Open (PPO) a good plan? Wellcare Giveback Open (PPO) received a 3 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Wellcare Giveback Open Reviews among several different plans.

2022 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
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H5439-015 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 Plans Performance

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


Health Plan Customer Service Rating for Wellcare by Health Net

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


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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Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Wellcare Giveback Open (PPO) requires you to live in that plan’s service area. The service area is listed below:



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How much does Wellcare Giveback Open (PPO) cost?

Wellcare by Health Net charges a $0 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Wellcare Giveback Open (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Wellcare Giveback Open (PPO) by Wellcare by Health Net MOOP is $7,550. Once you spend $7,550 you will pay nothing for Part A or Part B covered services.

What type of plan is Wellcare Giveback Open (PPO)?

Wellcare Giveback Open (PPO) is a Local PPO. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.

Is Wellcare Giveback Open (PPO) a good plan?

Wellcare Giveback Open (PPO) received a 3 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, 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 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*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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