2022 Wellcare Patriot No Premium (HMO)
Wellcare Patriot No Premium (HMO) H2134-006 is a 2022 Medicare Advantage Plan or Part-C by Wellcare by Allwell available to residents in New Mexico. This plan does not provide additional prescription drug (Part-D) coverage. The Wellcare Patriot No Premium (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay
$4,400 out-of-pocket. This can be a extremely nice safety net.
Wellcare Patriot No Premium (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.
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 Patriot No Premium (HMO) 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.
Ready to Enroll?
Click Here |
Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST
2022 Wellcare by Allwell Medicare Advantage Plan Costs
| Name: | Wellcare Patriot No Premium (HMO) |
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| Plan ID: | H2134-006 |
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| Provider: | Wellcare by Allwell |
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| Year: | 2022 |
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| Type: | Local HMO * |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: | |
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| MOOP: | $4,400 |
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| Similar Plan: | H2134-002 |
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| New Plan: | 2023 H2134-002 |
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2021 Wellcare Patriot No Premium (HMO) Summary of Benefits
*This will be updated with 2022 data when available.
Additional Benefits
Comprehensive Dental
| Diagnostic services |
$0 copay |
| Endodontics |
Not covered |
| Extractions |
Not covered |
| Non-routine services |
$0 copay |
| Periodontics |
Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services |
Not covered |
| Restorative services |
50% coinsurance |
Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) |
20% coinsurance |
| Diagnostic tests and procedures |
$0 copay |
| Lab services |
$0 copay |
| Outpatient x-rays |
$10 copay |
Doctor Visits
| Primary |
$0 copay |
| Specialist |
$35 copay per visit |
Emergency care/Urgent Care
| Emergency |
$90 copay per visit (always covered) |
| Urgent care |
$45 copay per visit (always covered) |
Foot Care (podiatry services)
| Foot exams and treatment |
$35 copay |
| Routine foot care |
Not covered |
Ground Ambulance
Hearing
| Fitting/evaluation |
Not covered |
| Hearing aids - inner ear |
Not covered |
| Hearing aids - outer ear |
Not covered |
| Hearing aids - over the ear |
Not covered |
| Hearing exam |
$35 copay |
Inpatient Hospital Coverage
$250 per day for days 1 through 5
$0 per day for days 6 through 90 |
|
|
Medical Equipment/Supplies
| Diabetes supplies |
$0 copay |
| Durable medical equipment (e.g., wheelchairs, oxygen) |
20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs) |
20% coinsurance per item |
Medicare Part B Drugs
| Chemotherapy |
20% coinsurance |
| Other Part B drugs |
20% coinsurance |
Mental Health Services
| Inpatient hospital - psychiatric |
$250 per day for days 1 through 5
$0 per day for days 6 through 90 |
| Outpatient group therapy visit |
$30 copay |
| Outpatient group therapy visit with a psychiatrist |
$30 copay |
| Outpatient individual therapy visit |
$30 copay |
| Outpatient individual therapy visit with a psychiatrist |
$30 copay |
MOOP
Option
Optional supplemental benefits
Outpatient Hospital Coverage
Preventive Care
Preventive Dental
| Cleaning |
$0 copay |
| Dental x-ray(s) |
$0 copay |
| Fluoride treatment |
$0 copay |
| Oral exam |
$0 copay |
Rehabilitation Services
| Occupational therapy visit |
$0 copay |
| Physical therapy and speech and language therapy visit |
$0 copay |
Skilled Nursing Facility
$0 per day for days 1 through 20
$184 per day for days 21 through 100 |
|
|
Transportation
Vision
| Contact lenses |
$0 copay |
| Eyeglass frames |
Not covered |
| Eyeglass lenses |
Not covered |
| Eyeglasses (frames and lenses) |
$0 copay |
| Other |
Not covered |
| Routine eye exam |
$0 copay |
| Upgrades |
Not covered |
Wellness Programs (e.g. fitness nursing hotline)
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 No Premium (HMO)
(Click county to compare all available Advantage plans)
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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.
