2022 Wellcare No Premium Open (PPO)
Wellcare No Premium Open (PPO) H4537-002 is a 2022 Medicare Advantage Plan or Part-C by Wellcare available to residents in Oklahoma. This plan includes additional prescription drug (Part-D) coverage. The Wellcare No Premium Open (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,900 out-of-pocket. This can be a extremely nice safety net.
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Wellcare No 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 works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Wellcare No 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 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 except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.
2022 Wellcare Medicare Advantage Plan Costs
| Name: | Wellcare No Premium Open (PPO) |
|---|---|
| Plan ID: | H4537-002 |
| Provider: | Wellcare |
| Year: | 2022 |
| Type: | Local PPO |
| Monthly Premium C+D: | $0 |
| Part C Premium: | $0.00 |
| MOOP: | $5,900 |
| Part D (Drug) Premium: | $0.00 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $0.00 |
| 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: | H4537-001 |
| New Plan: | 2023 H4537-001 |
Wellcare No Premium Open (PPO) Part-C Premium
Wellcare charges a $0.00 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.
H4537-002 Part-D Deductible and Premium
Wellcare No Premium Open (PPO) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Wellcare plan offers a $0.00 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 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 $0.00 . 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 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 plan does not offer additional coverage through the gap.
H4537-002 Formulary or Drug Coverage
Wellcare No 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 No Premium Open (PPO) H4537-002 Formulary here.
| Drug Tier | Copay Preferred Pharmacy |
Copay Nonpreferred Pharmacy |
|---|---|---|
| Tier 1 | $0 | $0 |
| Tier 2 | $7 | $12 |
| Tier 3 | $37 | $47 |
| Tier 4 | $90 | $100 |
| Tier 5 | 33% | 33% |
| Tier 6 | $0 | $0 |
Coverage Area for Wellcare No 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.