WellCare Choice (HMO)


Medicare Plan Details

2021 Plan
Monthly Premium
(select county for price)

 

by WellCare
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 3.5
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
$6,700 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

$0 copay
$45 copay per visit

Tests, labs, & imaging

$0-75 copay
$0 copay
$0-350 copay
$0 copay
$90 copay per visit (always covered)
$25 copay per visit (always covered)

Hospital Services

$288 per day for days 1 through 7
$0 per day for days 8 through 90
$350-400 copay per visit

Skilled nursing facility

$0 per day for days 1 through 20
$165 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

$225 copay

Therapy services

$40 copay
$40 copay

Mental health services

$40 copay
$40 copay
$40 copay
$40 copay

Opioid treatment services

Covered

Other services

20% coinsurance per item
20% coinsurance per item
$0 copay 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 :
$3.70 copay or 5% (whichever costs more)

Brand-name drugs :
$9.20 copay or 5% (whichever costs more)

Generic$10.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug40%
Specialty Tier33%
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

20% coinsurance
20% coinsurance

Extra Benefits

Hearing

$45 copay
$0 copay
$0 copay

Preventive Dental

$0 copay
$0 copay
$0 copay
$0 copay

Comprehensive dental

$0 copay
Not covered
$0 copay
Not covered
$0 copay
$0 copay
$0 copay

Vision

$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay

Other benefits

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

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