2022 Wellcare Patriot No Premium Open (PPO)

Wellcare Patriot No Premium Open (PPO) H5439-010 is a 2022 Medicare Advantage Plan or Part-C by Wellcare by Health Net available to residents in Oregon and Washington. This plan does not provide additional prescription drug (Part-D) coverage. The Wellcare Patriot No Premium Open (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $2,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $2,500 out-of-pocket. This can be a extremely nice safety net.

Wellcare Patriot 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 by Health Net 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 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 Health Net 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 Health Net except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Wellcare by Health Net Medicare Advantage Plan Costs

2021 Wellcare Patriot No Premium 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	$0 copay
Diagnostic services	0-50% coinsurance (Out-of-Network)
Endodontics	Not covered
Extractions	Not covered
Non-routine services	0-50% coinsurance (Out-of-Network)
Non-routine services	$0 copay
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	50% coinsurance
Restorative services	0-50% coinsurance (Out-of-Network)

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Deductible

$125 annual deductible

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	20% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	15% coinsurance
Diagnostic tests and procedures	0-15% coinsurance
Diagnostic tests and procedures	0-20% coinsurance (Out-of-Network)
Lab services	$0 copay
Lab services	$0 copay (Out-of-Network)
Outpatient x-rays	$12 copay
Outpatient x-rays	$20 copay (Out-of-Network)

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Doctor Visits

Primary	$12 copay per visit
Primary	$20 copay per visit (Out-of-Network)
Specialist	$40 copay per visit (Out-of-Network)
Specialist	$25 copay per visit

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Emergency care/Urgent Care

Emergency	$120 copay per visit (always covered)
Urgent care	$25 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$40 copay (Out-of-Network)
Foot exams and treatment	$25 copay
Routine foot care	Not covered

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Ground Ambulance

$100 copay
$100 copay (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	$0 copay (Out-of-Network)
Hearing aids	$0-1,580 copay
Hearing aids	$0-1,580 copay (Out-of-Network)
Hearing exam	$25 copay
Hearing exam	$40 copay (Out-of-Network)

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Inpatient Hospital Coverage

$175 per day for days 1 through 8 $0 per day for days 9 through 90
$200 per day for days 1 through 8 $0 per day for days 9 and beyond (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	0-20% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)	15% 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)	15% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	15% coinsurance
Chemotherapy	20% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance (Out-of-Network)
Other Part B drugs	15% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$200 per day for days 1 through 8 $0 per day for days 9 through 190 (Out-of-Network)
Inpatient hospital - psychiatric	$175 per day for days 1 through 8 $0 per day for days 9 through 90
Outpatient group therapy visit	$40 copay (Out-of-Network)
Outpatient group therapy visit	$25 copay
Outpatient group therapy visit with a psychiatrist	$25 copay
Outpatient group therapy visit with a psychiatrist	$40 copay (Out-of-Network)
Outpatient individual therapy visit	$25 copay
Outpatient individual therapy visit	$40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$25 copay

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MOOP

$5,100 In and Out-of-network $2,500 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

20% coinsurance per visit
$200 copay per visit (Out-of-Network)

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Preventive Care

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

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Preventive Dental

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

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Rehabilitation Services

Occupational therapy visit	$40 copay (Out-of-Network)
Occupational therapy visit	$25 copay
Physical therapy and speech and language therapy visit	$25 copay
Physical therapy and speech and language therapy visit	$40 copay (Out-of-Network)

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Skilled Nursing Facility

$0 per day for days 1 through 20 $220 per day for days 21 through 100 (Out-of-Network)
$0 per day for days 1 through 20 $184 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$10 copay
Routine eye exam	$10 copay (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Wellcare Patriot No Premium Open (PPO) H5439

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Wellcare Patriot No Premium Open (PPO) Plans Performance

Health Plan Customer Service Rating for Wellcare Patriot No Premium Open (PPO)

Wellcare Patriot No Premium Open (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

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 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.