2022 Blue Medicare Advantage Enhanced PPO (PPO)

Blue Medicare Advantage Enhanced PPO (PPO) H5900-002 is a 2022 Medicare Advantage Plan or Part-C by Wellmark Advantage Health Plan available to residents in Iowa. This plan includes additional prescription drug (Part-D) coverage. The Blue Medicare Advantage Enhanced PPO (PPO) has a monthly premium of $49.00 and has an in-network maximum out-of-pocket limit of $3,800 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,800 out-of-pocket. This can be a extremely nice safety net.

Blue Medicare Advantage Enhanced PPO (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Wellmark Advantage Health Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Blue Medicare Advantage Enhanced PPO (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Wellmark Advantage Health Plan and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Wellmark Advantage Health Plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Wellmark Advantage Health Plan Medicare Advantage Plan Costs

Blue Medicare Advantage Enhanced PPO (PPO) Part-C Premium

Wellmark Advantage Health Plan charges a $23.60 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H5900-002 Part-D Deductible and Premium

Blue Medicare Advantage Enhanced PPO (PPO) has a monthly drug premium of $25.40 and a $0.00 drug deductible. This Wellmark Advantage Health Plan plan offers a $25.40 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Wellmark Advantage Health Plan above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $25.40 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Wellmark Advantage Health Plan Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Wellmark Advantage Health Plan plan does not offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Blue Medicare Advantage Enhanced PPO (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.30 for 75% low income subsidy $12.70 for 50% and $19.00 for 25%.

H5900-002 Formulary or Drug Coverage

Blue Medicare Advantage Enhanced PPO (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Blue Medicare Advantage Enhanced PPO (PPO) H5900-002 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$0	$6
Tier 2	$8	$14
Tier 3	$35	$36
Tier 4	$100	$100
Tier 5	33%	33%

*Initial Coverage Phase and 30 day supply

Ready to Enroll?

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1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Blue Medicare Advantage Enhanced PPO (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.