Allwell Medicare (HMO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Allwell
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
No Rating
out of 5 stars

State: Louisiana

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
$40 per visit

Tests, labs, & imaging

$0 copay
$0 copay
$125
$40
$90 per visit (always covered)
$35 per visit (always covered)

Hospital Services

$90 per day for days 1 through 10
$0 per day for days 11 through 90
$160 per visit

Skilled nursing facility

$0 per day for days 1 through 20
$170 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

$250

Therapy services

$15
$15

Mental health services

$40
$40
$40
$40

Opioid treatment services

Covered

Other services

20% per item
20% per item
$0 copay

Prescription Drug Benefits

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$5.00 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$15.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%

Part B Drugs

20%
20%

Extra Benefits

Hearing

$40
$0 copay
$0-1,580

Preventive Dental

$0 copay
$0 copay
Not covered
$0 copay

Comprehensive dental

20%
$0 copay
20%
30%
30%
30%
30%

Vision

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

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Not covered
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating

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