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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
3.5out 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
Plan Details
$0
$0
$0
$125 annual deductible
$5,100 In and Out-of-network
$2,500 In-network
$2,500 In-network
No
Yes
Yes
Yes
Medical Benefits
Doctor Services
In-network: $12 copay per visit
Out-of-network: $0-250 copay per visit
Out-of-network: $0-250 copay per visit
In-network: $25 copay per visit
Out-of-network: $0-250 copay per visit
Out-of-network: $0-250 copay per visit
Tests, labs, & imaging
In-network: $0 copay or 15% coinsurance
Out-of-network: $0 copay or 20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0-225 copay
Out-of-network: 20-40% coinsurance
Out-of-network: 20-40% coinsurance
In-network: $0 copay
Out-of-network: $0-250 copay
Out-of-network: $0-250 copay
$120 copay per visit (always covered)
$25 copay per visit (always covered)
Hospital Services
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
$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
In-network: $225 copay per visit
Out-of-network: $0-250 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
$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
Out-of-network: $0 copay
Ambulance
In-network: $100 copay
Out-of-network: $0-250 copay
Out-of-network: $0-250 copay
Therapy services
In-network: $25 copay
Out-of-network: $0-250 copay
Out-of-network: $0-250 copay
In-network: $25 copay
Out-of-network: $0-250 copay
Out-of-network: $0-250 copay
Mental health services
In-network: $25 copay
Out-of-network: $0-250 copay
Out-of-network: $0-250 copay
In-network: $25 copay
Out-of-network: $0-250 copay
Out-of-network: $0-250 copay
In-network: $25 copay
Out-of-network: $0-250 copay
Out-of-network: $0-250 copay
In-network: $25 copay
Out-of-network: $0-250 copay
Out-of-network: $0-250 copay
Opioid treatment services
Covered
Other services
In-network: 20% coinsurance per item
Out-of-network: 20-40% coinsurance per item
Out-of-network: 20-40% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 20-40% coinsurance per item
Out-of-network: 20-40% coinsurance per item
In-network: $0 copay per item
Out-of-network: $0 copay or 30% coinsurance 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
In-network: 20% coinsurance
Out-of-network: 20-40% coinsurance
Out-of-network: 20-40% coinsurance
In-network: 20% coinsurance
Out-of-network: 20-40% coinsurance
Out-of-network: 20-40% coinsurance
Extra Benefits
Hearing
In-network: $25 copay
Out-of-network: $0-250 copay
Out-of-network: $0-250 copay
In-network: $0 copay
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
In-network: $0 copay
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Preventive Dental
In-network: $0 copay
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
In-network: $0 copay
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
In-network: $0 copay
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
In-network: $0 copay
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
Comprehensive dental
In-network: 40% coinsurance
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
In-network: 40% coinsurance
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
In-network: 40% coinsurance
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
In-network: 40% coinsurance
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
In-network: 40% coinsurance
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
In-network: 40% coinsurance
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
In-network: 40% coinsurance
Out-of-network: 70% coinsurance
Out-of-network: 70% coinsurance
Vision
In-network: $0 copay
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
In-network: $0 copay
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
In-network: $0 copay
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
In-network: $0 copay
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
In-network: $0 copay
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
In-network: $0 copay
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Other benefits
Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
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