Wellcare Mutual of Omaha No Premium Open (PPO)
Washington Medicare Advantage Plan (2024 Plan)
Monthly Premium

Additional Coverage
Overall Government Star Rating
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Plan Overview
Wellcare Mutual of Omaha No Premium Open (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Washington 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 Mutual of Omaha No Premium Open (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $10,000 In and Out-of-network $6,700 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 Mutual of Omaha No Premium Open (PPO) are defined below.
Additional Benefits and Coverage
Wellcare Mutual of Omaha No Premium Open (PPO) 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 Mutual of Omaha No Premium Open (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Wellcare Mutual of Omaha No Premium Open (PPO) includes coverage for the following additional benefits:
Other benefits
Plan Benefits and Coverage Details
$6,700 In-network
Medical Benefits
Doctor Services
Out-of-network: $35 copay per visit
Out-of-network: $65 copay 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
$0 per day for days 6 through 90
Out-of-network: 30% per day for days 1 through 90
Out-of-network: 40% coinsurance per visit
Skilled nursing facility
$203 per day for days 21 through 60
$0 per day for days 61 through 100
Out-of-network: 30% per day for days 1 through 100
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: $300 copay
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: 20-40% 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 | $0.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
Generic | $10.00 copay | ||
Preferred Brand | $47.00 copay | ||
Non-Preferred Drug | 50% | ||
Specialty Tier | 31% |
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: $65 copay
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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