2022 Wellcare TexanPlus No Premium (HMO-POS)

Wellcare TexanPlus No Premium (HMO-POS) H4506-029 is a 2022 Medicare Advantage Plan or Part-C by Wellcare available to residents in Texas. This plan includes additional prescription drug (Part-D) coverage. The Wellcare TexanPlus No Premium (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,400 out-of-pocket. This can be a extremely nice safety net.

Wellcare TexanPlus No Premium (HMO-POS) 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 works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Wellcare TexanPlus No Premium (HMO-POS) 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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2022 Wellcare Medicare Advantage Plan Costs

Wellcare TexanPlus No Premium (HMO-POS) 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.

H4506-029 Part-D Deductible and Premium

Wellcare TexanPlus No Premium (HMO-POS) has a monthly drug premium of $0.00 and a $250.00 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 offer additional coverage through the gap.

H4506-029 Formulary or Drug Coverage

Wellcare TexanPlus No Premium (HMO-POS) 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 TexanPlus No Premium (HMO-POS) H4506-029 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$0	$0
Tier 2	$0	$5
Tier 3	$30	$40
Tier 4	$90	$100
Tier 5	28%	28%
Tier 6	$0	$0

*Initial Coverage Phase and 30 day supply

2021 Wellcare TexanPlus No Premium (HMO-POS) 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
Non-routine services	$0 copay
Periodontics	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Restorative services	$0 copay

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$0-240 copay
Diagnostic radiology services (e.g., MRI)	40% coinsurance (Out-of-Network)
Diagnostic tests and procedures	40% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0 copay
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	$0 copay
Specialist	40% coinsurance per visit (Out-of-Network)
Specialist	$40 copay per visit

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Emergency care/Urgent Care

Emergency	$120 copay per visit (always covered)
Urgent care	$35 copay per visit (always covered)

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Foot Care (podiatry services)

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

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Ground Ambulance

$300 copay
40% coinsurance (Out-of-Network)

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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	40% coinsurance (Out-of-Network)
Hearing exam	$40 copay

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Inpatient Hospital Coverage

$300 per day for days 1 through 6 $0 per day for days 7 through 90
40% per stay (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	$0 copay per item
Diabetes supplies	40% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	40% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	40% 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	20% coinsurance
Chemotherapy	40% coinsurance (Out-of-Network)
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	$250 per day for days 1 through 5 $0 per day for days 6 through 90
Inpatient hospital - psychiatric	40% per stay (Out-of-Network)
Outpatient group therapy visit	40% coinsurance (Out-of-Network)
Outpatient group therapy visit	$40 copay
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 $3,400 In-network $10,000 Out-of-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)
$240 copay per visit

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Preventive Care

40% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

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

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Rehabilitation Services

Occupational therapy visit	$35 copay
Occupational therapy visit	40% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	40% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$35 copay

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Skilled Nursing Facility

$0 per day for days 1 through 20 $150 per day for days 21 through 100
40% per stay (Out-of-Network)

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Transportation

Not covered

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Vision

Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$0 copay
Upgrades	$0 copay

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Wellcare TexanPlus No Premium (HMO-POS) H4506

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 TexanPlus No Premium (HMO-POS) Plans Performance

Health Plan Customer Service Rating for Wellcare TexanPlus No Premium (HMO-POS)

Wellcare TexanPlus No Premium (HMO-POS) 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 TexanPlus No Premium (HMO-POS)

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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.