2022 Wellcare Low Premium Open (PPO)
Wellcare Low Premium Open (PPO) H9976-003 is a 2022 Medicare Advantage Plan or Part-C by Wellcare by Allwell available to residents in New Mexico. This plan includes additional prescription drug (Part-D) coverage. The Wellcare Low Premium Open (PPO) has a monthly premium of $35.00 and has an in-network maximum out-of-pocket limit of $4,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,700 out-of-pocket. This can be a extremely nice safety net.
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Wellcare Low Premium Open (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.
Wellcare by Allwell works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Wellcare Low Premium Open (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Wellcare by Allwell 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 Wellcare by Allwell except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.
2022 Wellcare by Allwell Medicare Advantage Plan Costs
| Name: | Wellcare Low Premium Open (PPO) |
|---|---|
| Plan ID: | H9976-003 |
| Provider: | Wellcare by Allwell |
| Year: | 2022 |
| Type: | Local PPO |
| Monthly Premium C+D: | $35.00 |
| Part C Premium: | $27.00 |
| MOOP: | $4,700 |
| Part D (Drug) Premium: | $8.00 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $8.00 |
| Drug Deductible: | $0.00 |
| Tiers with No Deductible: | 0 |
| Gap Coverage: | No |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Similar Plan: | H9976-004 |
| New Plan: | 2023 H9976-004 |
Wellcare Low Premium Open (PPO) Part-C Premium
Wellcare by Allwell charges a $27.00 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.
H9976-003 Part-D Deductible and Premium
Wellcare Low Premium Open (PPO) has a monthly drug premium of $8.00 and a $0.00 drug deductible. This Wellcare by Allwell plan offers a $8.00 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 Wellcare by Allwell 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 $8.00 . 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.
Wellcare by Allwell 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 Wellcare by Allwell 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 Wellcare Low Premium Open (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $2.00 for 75% low income subsidy $4.00 for 50% and $6.00 for 25%.
| Full LIS Premium: | $0.00 |
|---|---|
| 75% LIS Premium: | $2.00 |
| 50% LIS Premium: | $4.00 |
| 25% LIS Premium: | $6.00 |
H9976-003 Formulary or Drug Coverage
Wellcare Low Premium Open (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 Wellcare Low Premium Open (PPO) H9976-003 Formulary here.
| Drug Tier | Copay Preferred Pharmacy |
Copay Nonpreferred Pharmacy |
|---|---|---|
| Tier 1 | $0 | $0 |
| Tier 2 | $5 | $10 |
| Tier 3 | $37 | $47 |
| Tier 4 | 43% | 45% |
| Tier 5 | 33% | 33% |
| Tier 6 | $0 | $0 |
Coverage Area for Wellcare Low Premium Open (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.