Wellcare Patriot Giveback (HMO-POS)


Medicare Plan Details

2022 Plan
Monthly Premium
(select county for price)

 

by Wellcare
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 3.5
out of 5 stars

State: Arkansas

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

$0
$0
$0
$0
$4,500 In and Out-of-network
$4,500 In-network
$4,500 Out-of-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $0 copay
Out-of-network: 20% coinsurance per visit
In-network: $35 copay per visit
Out-of-network: 20% coinsurance per visit

Tests, labs, & imaging

In-network: $0-20 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0-150 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
$90 copay per visit (always covered)
$35 copay per visit (always covered)

Hospital Services

In-network: $350 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 20% per day for days 1 through 90
In-network: $150 copay per visit
Out-of-network: 20% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$165 per day for days 21 through 100
Out-of-network: 20% per day for days 1 through 100

Preventive services

In-network: $0 copay
Out-of-network: 20% coinsurance

Ambulance

In-network: $200 copay
Out-of-network: 20% coinsurance

Therapy services

In-network: $35 copay
Out-of-network: 20% coinsurance
In-network: $35 copay
Out-of-network: 20% coinsurance

Mental health services

In-network: $40 copay
Out-of-network: 20% coinsurance
In-network: $40 copay
Out-of-network: 20% coinsurance
In-network: $40 copay
Out-of-network: 20% coinsurance
In-network: $40 copay
Out-of-network: 20% coinsurance

Opioid treatment services

Covered

Other services

In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

In-network: 20% coinsurance
Out-of-network: 20% coinsurance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Extra Benefits

Hearing

In-network: $35 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Preventive Dental

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Comprehensive dental

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Vision

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
 3.5
 2
 3
 3
 4
 5

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