WellCare Premier (PPO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by WellCare
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 3.0
out of 5 stars

State: Georgia

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

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

 

$0
$0
$0
$0
$10,000 In and Out-of-network
$5,500 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $5 per visit
Out-of-network: $50 per visit
In-network: $40 per visit
Out-of-network: $50 per visit

Tests, labs, & imaging

In-network: $0-100
Out-of-network: 40%
In-network: $20
Out-of-network: 40%
In-network: $0-275
Out-of-network: 40%
In-network: $25
Out-of-network: 40%
$90 per visit (always covered)
$30 per visit (always covered)

Hospital Services

In-network: $300 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 40% per day for days 1 through 90
In-network: $300-325 per visit
Out-of-network: 40% per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$167.50 per day for days 21 through 100
Out-of-network: 40% per day for days 1 through 100

Preventive services

In-network: $0 copay
Out-of-network: $0 copay

Ambulance

In-network: $265
Out-of-network: $265

Therapy services

In-network: $40
Out-of-network: $50
In-network: $40
Out-of-network: $50

Mental health services

In-network: $40
Out-of-network: $50
In-network: $40
Out-of-network: $50
In-network: $40
Out-of-network: $50
In-network: $40
Out-of-network: $50

Opioid treatment services

Covered

Other services

In-network: 20% per item
Out-of-network: 40% per item
In-network: 20% per item
Out-of-network: 40% per item
In-network: $0 per item
Out-of-network: 20% per item

Prescription Drug Benefits

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

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$0.00 copay$0.00 copay


Generic drugs :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

Generic$5.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug45%
Specialty Tier31%
1 * The above cost-sharing only applies to some drugs on this tier. For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

In-network: 20%
Out-of-network: 40%
In-network: 20%
Out-of-network: 40%

Extra Benefits

Hearing

In-network: $40
Out-of-network: $50
In-network: $0 copay
Out-of-network: 50%
In-network: $0 copay
Out-of-network: 50%

Preventive Dental

In-network: $0 copay
Out-of-network: 20-70%
In-network: $0 copay
Out-of-network: 20-70%
In-network: $0 copay
Out-of-network: 20-70%
In-network: $0 copay
Out-of-network: 20-70%

Comprehensive dental

Not covered
In-network: $0
Out-of-network: 20-70%
In-network: 20%
Out-of-network: 20-70%
In-network: 50%
Out-of-network: 20-70%
In-network: 50%
Out-of-network: 20-70%
In-network: 20%
Out-of-network: 20-70%
In-network: 50%
Out-of-network: 20-70%

Vision

In-network: $0 copay
Out-of-network: 50%
In-network: $0 copay
Out-of-network: 50%
In-network: $0 copay
Out-of-network: 50%
In-network: $0 copay
Out-of-network: 50%
In-network: $0 copay
Out-of-network: 50%
Not covered

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Not covered
 3
 3
No Rating
 2
 3
No Rating
 3
 4
 3
 3
 3

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