'Ohana Plus (HMO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

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

State: Hawaii

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

 

$16
$0
$16
$185 In-network
$3,400 In-network
No
No
No
Yes

Medical Benefits

Doctor Services

20% per visit
20% per visit

Tests, labs, & imaging

20%
$0
20%
20%
$120 per visit (always covered)
$50 per visit (always covered)

Hospital Services

$2,400 per stay
20% per visit

Skilled nursing facility

$0 per day for days 1 through 20
$178 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

20%

Therapy services

20%
20%

Mental health services

20%
20%
20%
20%

Opioid treatment services

Covered

Other services

20% per item
20% per item
20% per item

Prescription Drug Benefits

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

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


Generic drugs :
25%

Brand-name drugs :
25%


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

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

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug41%
Specialty Tier25%

Part B Drugs

20%
20%

Extra Benefits

Hearing

20%
Not covered
Not covered
Not covered
Not covered

Preventive Dental

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

Comprehensive dental

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

Vision

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Other benefits

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

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