WellCare Patriot (PPO)


Medicare Plan Details

2021 Plan
Monthly Premium
(select county for price)

 

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

State: Missouri

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

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

 

$0
$0
$0
$0
$10,000 In and Out-of-network
$4,000 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $0 copay
Out-of-network: 40% coinsurance per visit
In-network: $25 copay per visit
Out-of-network: 40% coinsurance per visit

Tests, labs, & imaging

In-network: $0-50 copay
Out-of-network: 40% coinsurance
In-network: $0 copay
Out-of-network: 40% coinsurance
In-network: $0-250 copay
Out-of-network: 40% coinsurance
In-network: $0 copay
Out-of-network: 40% coinsurance
$90 copay per visit (always covered)
$30 copay per visit (always covered)

Hospital Services

In-network: $325 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 20% per day for days 1 through 90
In-network: $250 copay per visit
Out-of-network: 40% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: 20% per day for days 1 through 100

Preventive services

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

Ambulance

In-network: $240 copay
Out-of-network: $240 copay

Therapy services

In-network: $40 copay
Out-of-network: 40% coinsurance
In-network: $40 copay
Out-of-network: 40% coinsurance

Mental health services

In-network: $40 copay
Out-of-network: 40% coinsurance
In-network: $40 copay
Out-of-network: 40% coinsurance
In-network: $40 copay
Out-of-network: 40% coinsurance
In-network: $40 copay
Out-of-network: 40% coinsurance

Opioid treatment services

Covered

Other services

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

Prescription Drug Benefits

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

Part B Drugs

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

Extra Benefits

Hearing

In-network: $25 copay
Out-of-network: 40% coinsurance
In-network: $0 copay
Out-of-network: 40% coinsurance
In-network: $0 copay
Out-of-network: 40% coinsurance

Preventive Dental

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

Comprehensive dental

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

Vision

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

Other benefits

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

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