Wellcare Dual Liberty Open (PPO D-SNP)
Rhode Island Medicare-Medicaid Dual Eligible D-SNP Plan (2023 Plan)
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Additional Coverage
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Plan Overview
Wellcare Dual Liberty Open (PPO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Rhode Island 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 Liberty 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 $12,450 In and Out-of-network $8,300 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 Liberty Open (PPO D-SNP) are defined below.
Additional Benefits and Coverage
Wellcare Dual Liberty 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 Liberty Open (PPO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Wellcare Dual Liberty Open (PPO D-SNP) includes coverage for the following additional benefits:
Other benefits
Plan Benefits and Coverage Details
$8,300 In-network
Medical Benefits
Doctor Services
Out-of-network: 40% coinsurance per visit
Out-of-network: 40% coinsurance per visit
Tests, labs, & imaging
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Hospital Services
Out-of-network: $2,050 per stay
Out-of-network: 40% coinsurance per visit
Skilled nursing facility
Out-of-network: $0 per day for days 1 through 20
$196 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: 40% coinsurance
Out-of-network: 40% coinsurance
Mental health services
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Opioid treatment services
Other services
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Out-of-network: 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: 40% coinsurance
Out-of-network: 40% coinsurance
Extra Benefits
Hearing
Out-of-network: 40% 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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