2023 Wellcare Patriot Giveback Open (PPO)

Wellcare Patriot Giveback Open (PPO) H8553-002 is a 2023 Medicare Advantage Plan or Part-C by Wellcare available to residents in Arizona. This plan does not provide additional prescription drug (Part-D) coverage. Wellcare Wellcare Patriot Giveback Open (PPO) 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 an extremely nice safety net.

Wellcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Wellcare Patriot 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 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 except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Arizona.




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2023 Wellcare Medicare Advantage Plan Overview

Name:Wellcare Patriot Giveback Open (PPO)
Plan ID:H8553 002 0
Provider:Wellcare
Year:2023
Type:Local PPO *
Combined Premium (C+D):$0/mo
MOOP:$4,400/yr
Similar Plan: H8553-001




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

Wellcare Patriot 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 Patriot Giveback Open (PPO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Wellcare charges a $0 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.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Wellcare Patriot Giveback Open (PPO) by Wellcare MOOP is $4,400. Once you spend $4,400 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.





2023 Summary of Benefits


The benefit information provided is a summary of what Wellcare Patriot 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 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.

Wellness programs (e.g., fitness, nursing hotline)Covered



Contact lenses


In-Network Vision$0 copay
Out-of-Network Vision40% coinsurance



Eyeglass frames


In-Network Vision$0 copay
Out-of-Network Vision40% coinsurance



Eyeglass lenses


In-Network Vision$0 copay
Out-of-Network Vision40% coinsurance



Eyeglasses (frames and lenses)


In-Network Vision$0 copay
Out-of-Network Vision40% coinsurance



Other


VisionNot covered



Routine eye exam


In-Network Vision$0 copay
Out-of-Network Vision40% coinsurance



Upgrades


In-Network Vision$0 copay
Out-of-Network Vision40% coinsurance




Out-of-Network Transportation75% coinsurance
In-Network Transportation$0 copay
In-Network Skilled Nursing Facility$0 per day for days 1 through 20
$196 per day for days 21 through 50
$0 per day for days 51 through 100
Out-of-Network Skilled Nursing Facility20% per day for days 1 through 100



Occupational therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services40% coinsurance



Physical therapy and speech and language therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services40% coinsurance



Cleaning


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental50% coinsurance



Dental x-ray(s)


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental50% coinsurance



Fluoride treatment


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental50% coinsurance



Oral exam


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental50% coinsurance




Out-of-Network Preventive care$0 copay
In-Network Preventive care$0 copay
Out-of-Network Outpatient hospital coverage40% coinsurance per visit
In-Network Outpatient hospital coverage$200 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


In-Network Mental health services$225 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network Mental health services40% per day for days 1 through 90



Outpatient group therapy visit


In-Network Mental health services$25 copay
Out-of-Network Mental health services40% coinsurance



Outpatient group therapy visit with a psychiatrist


In-Network Mental health services$25 copay
Out-of-Network Mental health services40% coinsurance



Outpatient individual therapy visit


In-Network Mental health services$25 copay
Out-of-Network Mental health services40% coinsurance



Outpatient individual therapy visit with a psychiatrist


Out-of-Network Mental health services40% coinsurance
In-Network Mental health services$25 copay



Chemotherapy


Out-of-Network Medicare Part B drugs40% coinsurance
In-Network Medicare Part B drugs20% coinsurance



Other Part B drugs


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs40% coinsurance



Diabetes supplies


Out-of-Network Medical equipment/supplies40% coinsurance per item
In-Network Medical equipment/supplies$0 copay per item



Durable medical equipment (e.g., wheelchairs, oxygen)


Out-of-Network Medical equipment/supplies40% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


Out-of-Network Medical equipment/supplies40% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$8,950 In and Out-of-network
$4,400 In-network
In-Network Inpatient hospital coverage$250 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network Inpatient hospital coverage40% per day for days 1 through 90



Fitting/evaluation


Out-of-Network Hearing40% coinsurance
In-Network Hearing$0 copay



Hearing aids


Out-of-Network Hearing40% coinsurance
In-Network Hearing$0 copay



Hearing exam


In-Network Hearing$40 copay
Out-of-Network Hearing40% coinsurance




Health plan deductible$0
In-Network Ground ambulance$230 copay
Out-of-Network Ground ambulance$335 copay



Foot exams and treatment


In-Network Foot care (podiatry services)$40 copay
Out-of-Network Foot care (podiatry services)40% coinsurance



Routine foot care


In-Network Foot care (podiatry services)$40 copay
Out-of-Network Foot care (podiatry services)40% coinsurance



Emergency


Emergency care/Urgent care$110 copay per visit (always covered)



Urgent care


Emergency care/Urgent care$40 copay per visit (always covered)



Primary


In-Network Doctor visits$0 copay
Out-of-Network Doctor visits40% coinsurance per visit



Specialist


Out-of-Network Doctor visits40% coinsurance per visit
In-Network Doctor visits$40 copay per visit



Diagnostic radiology services (e.g., MRI)


Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0-200 copay



Diagnostic tests and procedures


In-Network Diagnostic procedures/lab services/imaging$0-40 copay
Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance



Lab services


In-Network Diagnostic procedures/lab services/imaging$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance



Outpatient x-rays


In-Network Diagnostic procedures/lab services/imaging$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance



Diagnostic services


In-Network Comprehensive dental$0 copay
Out-of-Network Comprehensive dental50% coinsurance



Endodontics


Out-of-Network Comprehensive dental50% coinsurance
In-Network Comprehensive dental$0 copay



Extractions


Out-of-Network Comprehensive dental50% coinsurance
In-Network Comprehensive dental$0 copay



Non-routine services


Out-of-Network Comprehensive dental50% coinsurance
In-Network Comprehensive dental$0 copay



Periodontics


Out-of-Network Comprehensive dental50% coinsurance
In-Network Comprehensive dental$0 copay



Prosthodontics, other oral/maxillofacial surgery, other services


In-Network Comprehensive dental$0 copay
Out-of-Network Comprehensive dental50% coinsurance



Restorative services


Out-of-Network Comprehensive dental50% coinsurance
In-Network Comprehensive dental$0 copay




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No





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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 Patriot 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 Patriot Giveback Open (PPO) cost?

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

How much is Wellcare Patriot Giveback Open (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Wellcare Patriot Giveback Open (PPO) by Wellcare MOOP is $4,400. Once you spend $4,400 you will pay nothing for Part A or Part B covered services.

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

Wellcare Patriot 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.



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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