Wellcare Patriot No Premium Open (PPO)

Medicare Plan Details (2022 Plan)

Monthly Premium

by Wellcare by Health Net

Additional Coverage

HearingVisionDental

Overall Government Star Rating

3.5

out of 5 stars

Ready to Enroll Online?

Plan Type

Medicare Advantage (Part C)

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

Monthly Premium

Health Portion of Premium

Drug Portion of Premium

Health Plan Deductible

$125 annual deductible

Health Plan Max Out-of-Pocket

$5,100 In and Out-of-network
$2,500 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

http://www.wellcare.com/healthnetOR

Plan Link

http://www.wellcare.com/healthnetOR

Medical Benefits

Doctor Services

Primary doctor visit

In-network: $12 copay per visit
Out-of-network: $0-250 copay per visit

Specialist visit

In-network: $25 copay per visit
Out-of-network: $0-250 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $0 copay or 15% coinsurance
Out-of-network: $0 copay or 20% coinsurance

Lab services

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

Diagnostic radiology services (like MRI)

In-network: $0-225 copay
Out-of-network: 20-40% coinsurance

Outpatient x-rays

In-network: $0 copay
Out-of-network: $0-250 copay

Emergency care

$120 copay per visit (always covered)

Urgent care

$25 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $175 per day for days 1 through 8
$0 per day for days 9 through 90
Out-of-network: $200 per day for days 1 through 8
$0 per day for days 9 and beyond

Outpatient hospital coverage

In-network: $225 copay per visit
Out-of-network: $0-250 copay per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$220 per day for days 21 through 100

Preventive services

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

Ambulance

Ground ambulance

In-network: $100 copay
Out-of-network: $0-250 copay

Therapy services

Occupational therapy visit

In-network: $25 copay
Out-of-network: $0-250 copay

Physical therapy & speech & language therapy visit

In-network: $25 copay
Out-of-network: $0-250 copay

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $25 copay
Out-of-network: $0-250 copay

Outpatient individual therapy with a psychiatrist

In-network: $25 copay
Out-of-network: $0-250 copay

Outpatient group therapy visit

In-network: $25 copay
Out-of-network: $0-250 copay

Outpatient individual therapy visit

In-network: $25 copay
Out-of-network: $0-250 copay

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

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

Prosthetics (like braces, artificial limbs)

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

Diabetes supplies

In-network: $0 copay per item
Out-of-network: $0 copay or 30% coinsurance per item

Prescription Drug Benefits

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

Part B Drugs

Chemotherapy drugs

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

Other Part B drugs

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

Extra Benefits

Hearing

Hearing exam

In-network: $25 copay
Out-of-network: $0-250 copay

Fitting/evaluation

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

Hearing aids - All types

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

Preventive Dental

Oral exam

In-network: $0 copay
Out-of-network: 70% coinsurance

Cleaning

In-network: $0 copay
Out-of-network: 70% coinsurance

Fluoride treatment

In-network: $0 copay
Out-of-network: 70% coinsurance

Dental x-rays

In-network: $0 copay
Out-of-network: 70% coinsurance

Comprehensive dental

Non-routine services

In-network: 40% coinsurance
Out-of-network: 70% coinsurance

Diagnostic services

In-network: 40% coinsurance
Out-of-network: 70% coinsurance

Restorative services

In-network: 40% coinsurance
Out-of-network: 70% coinsurance

Endodontics

In-network: 40% coinsurance
Out-of-network: 70% coinsurance

Periodontics

In-network: 40% coinsurance
Out-of-network: 70% coinsurance

Extractions

In-network: 40% coinsurance
Out-of-network: 70% coinsurance

Prosthodontics, other oral/maxillofacial surgery, other services

In-network: 40% coinsurance
Out-of-network: 70% coinsurance

Vision

Routine eye exam

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

Contact lenses

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

Eyeglasses (frames & lenses)

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

Eyeglass frames (only)

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

Eyeglass lenses (only)

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

Upgrades

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

Other benefits

Fitness benefit

Limited coverage

Over the counter drug benefits

Not covered

In-home support services

Not covered

Home and bathroom safety devices

Not covered

Meals for short duration

Not covered

Annual physical exams

Limited coverage

Telehealth

Limited coverage

Summary rating of health plan quality

3.5

Staying healthy: screenings, tests, & vaccines

Managing chronic (long term) conditions

Member experience with health plan

Member complaints & changes in the health plan's performance

Health plan customer service

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(888) 763-2752

TTY 711

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Wellcare Patriot No Premium Open (PPO)

Medicare Plan Details (2022 Plan)

Monthly Premium

by Wellcare by Health Net

Additional Coverage

Overall Government Star Rating

Ready to Enroll Online?

Plan Type

Medicare Advantage (Part C)

Plan Details

Medical Benefits

Doctor Services

Tests, labs, & imaging

Hospital Services

Skilled nursing facility

Preventive services

Ambulance

Therapy services

Mental health services

Opioid treatment services

Other services

Prescription Drug Benefits

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

Part B Drugs

Extra Benefits

Hearing

Preventive Dental

Comprehensive dental

Vision

Other benefits

Health Plan Star Ratings

(government star ratings are out of 5 stars)

When Can I Sign Up for Medicare?

Ready to Enroll Online?

Medicare Health Plans

Get Advice & Sign Up Help