2022 Wellcare Patriot Giveback Open (PPO)

Wellcare Patriot Giveback Open (PPO) H5965-003 is a 2022 Medicare Advantage Plan or Part-C by Wellcare available to residents in Washington. This plan does not provide additional prescription drug (Part-D) coverage. The Wellcare Patriot Giveback Open (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,000 out-of-pocket. This can be a extremely nice safety net.

Wellcare Patriot Giveback 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 Patriot Giveback 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.

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Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

2022 Wellcare Medicare Advantage Plan Costs

2021 Wellcare Patriot Giveback Open (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	$0 copay
Extractions	50% coinsurance (Out-of-Network)
Non-routine services	50% coinsurance (Out-of-Network)
Non-routine services	$0 copay
Periodontics	50% coinsurance (Out-of-Network)
Periodontics	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	50% coinsurance (Out-of-Network)
Restorative services	50% coinsurance (Out-of-Network)
Restorative services	$0 copay

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$0-250 copay
Diagnostic radiology services (e.g., MRI)	40% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0-50 copay
Diagnostic tests and procedures	40% coinsurance (Out-of-Network)
Lab services	40% coinsurance (Out-of-Network)
Lab services	$0 copay
Outpatient x-rays	$0 copay
Outpatient x-rays	40% coinsurance (Out-of-Network)

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Doctor Visits

Primary	40% coinsurance per visit (Out-of-Network)
Primary	$20 copay per visit
Specialist	$50 copay per visit
Specialist	40% coinsurance per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$30 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$50 copay
Foot exams and treatment	40% coinsurance (Out-of-Network)
Routine foot care	$25 copay
Routine foot care	40% coinsurance (Out-of-Network)

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Ground Ambulance

$250 copay (Out-of-Network)
$250 copay

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Hearing

Fitting/evaluation	40% coinsurance (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	40% coinsurance (Out-of-Network)
Hearing aids	$0 copay
Hearing exam	40% coinsurance (Out-of-Network)
Hearing exam	$50 copay

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Inpatient Hospital Coverage

20% per day for days 1 through 90 (Out-of-Network)
$500 per day for days 1 through 3 $0 per day for days 4 through 90

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Medical Equipment/Supplies

Diabetes supplies	20% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	40% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	40% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$550 per day for days 1 through 3 $0 per day for days 4 through 90
Inpatient hospital - psychiatric	40% per day for days 1 through 90 (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	40% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	40% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	40% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	40% coinsurance (Out-of-Network)

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MOOP

$10,000 In and Out-of-network $4,000 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

40% coinsurance per visit (Out-of-Network)
$250 copay per visit

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Preventive Care

$0 copay
$0 copay (Out-of-Network)

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Preventive Dental

Cleaning	50% coinsurance (Out-of-Network)
Cleaning	$0 copay
Dental x-ray(s)	50% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	50% coinsurance (Out-of-Network)
Fluoride treatment	$0 copay
Oral exam	50% coinsurance (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	40% coinsurance (Out-of-Network)
Occupational therapy visit	$40 copay
Physical therapy and speech and language therapy visit	$40 copay
Physical therapy and speech and language therapy visit	40% coinsurance (Out-of-Network)

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Skilled Nursing Facility

$0 per day for days 1 through 20 $184 per day for days 21 through 100
20% per day for days 1 through 100 (Out-of-Network)

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Transportation

Not covered

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Vision

Contact lenses	40% coinsurance (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass frames	40% coinsurance (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglass lenses	40% coinsurance (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Eyeglasses (frames and lenses)	40% coinsurance (Out-of-Network)
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	40% coinsurance (Out-of-Network)
Upgrades	$0 copay
Upgrades	40% coinsurance (Out-of-Network)

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Wellness Programs (e.g. fitness nursing hotline)

Covered

Ready to Enroll?

Click Here

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

Coverage Area for Wellcare Patriot Giveback 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.