Allwell Medicare Essentials (HMO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Allwell
Additional Coverage
Vision Dental
Overall Government Star Rating
 4.5
out of 5 stars

State: Wisconsin

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

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

 

$0
$0
$0
$0
$4,900 In-network
No
No
Yes
Yes

Medical Benefits

Doctor Services

$10 per visit
$35 per visit

Tests, labs, & imaging

$0 copay
$0 copay
20%
$0 copay
$90 per visit (always covered)
$50 per visit (always covered)

Hospital Services

$320 per day for days 1 through 5
$0 per day for days 6 through 90
$320 per visit

Skilled nursing facility

$0 per day for days 1 through 20
$170 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

$200

Therapy services

$30
$30

Mental health services

$30
$30
$30
$30

Opioid treatment services

Covered

Other services

20% per item
20% per item
0-20% per item

Prescription Drug Benefits

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

Part B Drugs

20%
20%

Extra Benefits

Hearing

$35
Not covered
Not covered
Not covered
Not covered

Preventive Dental

$0 copay
$0 copay
Not covered
$0 copay

Comprehensive dental

Not covered
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay

Vision

$0 copay
$0 copay
$0 copay
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Not covered
 4
 3
 4
 4
 4
No Rating

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