Wellcare Dual Liberty Open (PPO D-SNP)

Rhode Island Medicare-Medicaid Dual Eligible D-SNP Plan (2023 Plan)


Monthly Premium
by Wellcare
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Rating (new plan)

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Plan Name
Wellcare Dual Liberty Open (PPO D-SNP)
Insurance Carrier
Wellcare
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
PPO

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.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$8,300
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 copay
Ambulance
$0 copay

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.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

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

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Limited coverage
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Not covered
Telehealth
Limited coverage

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$12,450 In and Out-of-network
$8,300 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: 40% coinsurance per visit
Specialist visit
In-network: $0 copay
Out-of-network: 40% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: 40% coinsurance
Lab services
In-network: $0 copay
Out-of-network: 40% coinsurance
Diagnostic radiology services (like MRI)
In-network: $0 copay
Out-of-network: 40% coinsurance
Outpatient x-rays
In-network: $0 copay
Out-of-network: 40% coinsurance
Emergency care
$0 copay
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
In-network: $0 copay
Out-of-network: $2,050 per stay
Outpatient hospital coverage
In-network: $0 copay
Out-of-network: 40% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 copay
Out-of-network: $0 per day for days 1 through 20
$196 per day for days 21 through 100

Preventive services

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

Ambulance

Ground ambulance
In-network: $0 copay
Out-of-network: 20% coinsurance

Therapy services

Occupational therapy visit
In-network: $0 copay
Out-of-network: 40% coinsurance
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: 40% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 copay
Out-of-network: 40% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Out-of-network: 40% coinsurance
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: 40% coinsurance
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: 40% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: $0 copay
Out-of-network: 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: $0 copay
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: 20% coinsurance per item

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$4.15 copay or 5% (whichever costs more)

Brand-name drugs :
$10.35 copay or 5% (whichever costs more)

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
In-network: $0 copay
Out-of-network: 40% coinsurance
Other Part B drugs
In-network: $0 copay
Out-of-network: 40% coinsurance

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: 40% coinsurance
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: 50% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 50% coinsurance
Fluoride treatment
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: 50% coinsurance

Comprehensive dental

Non-routine services
In-network: $0 copay
Out-of-network: 50% coinsurance
Diagnostic services
In-network: $0 copay
Out-of-network: 50% coinsurance
Restorative services
In-network: $0 copay
Out-of-network: 50% coinsurance
Endodontics
In-network: $0 copay
Out-of-network: 50% coinsurance
Periodontics
In-network: $0 copay
Out-of-network: 50% coinsurance
Extractions
In-network: $0 copay
Out-of-network: 50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: $0 copay
Out-of-network: 50% 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

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