Wellcare Dual Access Open (PPO D-SNP)
New York Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)
Monthly Premium
Additional Coverage
Overall Government Star Rating
3.0Ready to Enroll Online?
Plan Overview
Wellcare Dual Access Open (PPO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in New York and offered by the health insurance company Wellcare. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
Wellcare Dual Access Open (PPO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $13,300 In and Out-of-network $8,850 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Wellcare Dual Access Open (PPO D-SNP) are defined below.
Additional Benefits and Coverage
Wellcare Dual Access Open (PPO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Wellcare Dual Access Open (PPO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Wellcare Dual Access Open (PPO D-SNP) includes coverage for the following additional benefits:
Other benefits
Comparing the Quality Score of Wellcare Dual Access Open (PPO D-SNP) to Other Plans in New York
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Wellcare Dual Access Open (PPO D-SNP) received an overall government quality rating of 3.0 stars out of 5 stars.
Wellcare Dual Access Open (PPO D-SNP) performed worse than New York’s State average overall quality score of 3.4 stars.
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Wellcare Dual Access Open (PPO D-SNP) received 3 stars for its health plan quality score which is worse than the New York State average health plan quality score of 3.4 stars.
Wellcare Dual Access Open (PPO D-SNP) received 3 stars for its drug plan quality score which is worse than the New York State average drug plan quality score of 3.4 stars.
Plan Benefits and Coverage Details
$8,850 In-network
Medical Benefits
Doctor Services
Out-of-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Tests, labs, & imaging
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Hospital Services
Out-of-network: 20% per day for days 1 through 120
Out-of-network: 20% coinsurance per visit
Skilled nursing facility
Out-of-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: 20% coinsurance
Therapy services
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Other services
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Out-of-network: $0 copay or 20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic |
Brand-name drugs :
|
Brand-name drugs :
| |
| Generic | |||
| Preferred Brand | |||
| Non-Preferred Drug | |||
| Specialty Tier |
Part B Drugs
Out-of-network: $35 copay or 0-20% coinsurance
Out-of-network: $35 copay or 0-20% coinsurance
Extra Benefits
Hearing
Out-of-network: 20% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Preventive Dental
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Comprehensive dental
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Vision
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
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