Wellcare No Premium (HMO-POS)
Delaware Medicare Advantage Plan (2024 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Rating (new plan)
Plan Name
Wellcare No Premium (HMO-POS)
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Wellcare No Premium (HMO-POS) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Delaware and offered by the health insurance company Wellcare. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$50 copay per visit
ER visit
$100 copay per visit (always covered)
Wellcare No Premium (HMO-POS) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,850 In and Out-of-network
$8,850 In-network
$8,850 Out-of-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Wellcare No Premium (HMO-POS) are defined below.
Yes
Part D Prescription Drug Coverage
Wellcare No Premium (HMO-POS) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Wellcare No Premium (HMO-POS) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Wellcare No Premium (HMO-POS) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
$8,850 In and Out-of-network
$8,850 In-network
$8,850 Out-of-network
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: 50% coinsurance per visit
Specialist visit
In-network: $50 copay per visit
Out-of-network: 50% coinsurance per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0-20 copay
Out-of-network: 50% coinsurance
Lab services
In-network: $0-50 copay
Out-of-network: 50% coinsurance
Diagnostic radiology services (like MRI)
In-network: $0-300 copay
Out-of-network: 50% coinsurance
Outpatient x-rays
In-network: $35 copay
Out-of-network: 50% coinsurance
Emergency care
$100 copay per visit (always covered)
Urgent care
$40 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: $300 per day for days 1 through 8
$0 per day for days 9 through 90
Out-of-network: 50% per day for days 1 through 90
Outpatient hospital coverage
In-network: $0-350 copay per visit
Out-of-network: 50% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 70
$0 per day for days 71 through 100
Out-of-network: 50% per day for days 1 through 100
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: 50% coinsurance
Ambulance
Ground ambulance
In-network: $320 copay
Out-of-network: 50% coinsurance
Therapy services
Occupational therapy visit
In-network: $40 copay
Out-of-network: 50% coinsurance
Physical therapy & speech & language therapy visit
In-network: $40 copay
Out-of-network: 50% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $25 copay
Out-of-network: 50% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: $25 copay
Out-of-network: 50% coinsurance
Outpatient group therapy visit
In-network: $25 copay
Out-of-network: 50% coinsurance
Outpatient individual therapy visit
In-network: $25 copay
Out-of-network: 50% coinsurance
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 50% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 50% coinsurance per item
Diabetes supplies
In-network: $0 copay per item
Out-of-network: 50% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
---|
Preferred Generic | $2.00 copay |
Generic drugs :
25% Brand-name drugs :
25% |
Generic drugs :
$0 copay Brand-name drugs :
$0 copay |
Generic | $10.00 copay |
Preferred Brand | $47.00 copay |
Non-Preferred Drug | 50% |
Specialty Tier | 31% |
Part B Drugs
Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: $35 copay or 0-20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: $35 copay or 0-20% coinsurance
Hearing
Hearing exam
In-network: $50 copay
Out-of-network: 50% coinsurance
Fitting/evaluation
In-network: $0 copay
Out-of-network: No Data
Hearing aids - All types
In-network: $0 copay
Out-of-network: No Data
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: No Data
Cleaning
In-network: $0 copay
Out-of-network: No Data
Fluoride treatment
In-network: $0 copay
Out-of-network: No Data
Dental x-rays
In-network: $0 copay
Out-of-network: No Data
Comprehensive dental
Non-routine services
In-network: $0 copay
Out-of-network: No Data
Diagnostic services
In-network: $0 copay
Out-of-network: No Data
Restorative services
In-network: $0 copay
Out-of-network: No Data
Endodontics
In-network: $0 copay
Out-of-network: No Data
Periodontics
In-network: $0 copay
Out-of-network: No Data
Extractions
In-network: $0 copay
Out-of-network: No Data
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: $0 copay
Out-of-network: No Data
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: No Data
Contact lenses
In-network: $0 copay
Out-of-network: No Data
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: No Data
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: No Data
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: No Data
Upgrades
In-network: $0 copay
Out-of-network: No Data
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