2022 WellSense Medicare Advantage (HMO)
WellSense Medicare Advantage (HMO) H6851-001 is a 2022 Medicare Advantage Plan or Part-C by BMC HealthNet Plan available to residents in New Hampshire. This plan includes additional prescription drug (Part-D) coverage. The WellSense Medicare Advantage (HMO) has a monthly premium of $30.50 and has an in-network maximum out-of-pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out-of-pocket. This can be a extremely nice safety net.
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WellSense Medicare Advantage (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.
BMC HealthNet Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for WellSense Medicare Advantage (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from BMC HealthNet Plan 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 BMC HealthNet Plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.
2022 BMC HealthNet Plan Medicare Advantage Plan Costs
| Name: | WellSense Medicare Advantage (HMO) |
|---|---|
| Plan ID: | H6851-001 |
| Provider: | BMC HealthNet Plan |
| Year: | 2022 |
| Type: | Local HMO |
| Monthly Premium C+D: | $30.50 |
| Part C Premium: | $0.00 |
| MOOP: | $7,550 |
| Part D (Drug) Premium: | $30.50 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $30.50 |
| Drug Deductible: | $480.00 |
| Tiers with No Deductible: | 0 |
| Gap Coverage: | No |
| Benchmark: | below the regional benchmark |
| Type of Medicare Health: | Defined Standard Benefit |
| Drug Benefit Type: | Basic |
| Similar Plan: | H6851-001 |
| New Plan: | 2023 H6851-001 |
WellSense Medicare Advantage (HMO) Part-C Premium
BMC HealthNet Plan 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.
H6851-001 Part-D Deductible and Premium
WellSense Medicare Advantage (HMO) has a monthly drug premium of $30.50 and a $480.00 drug deductible. This BMC HealthNet Plan plan offers a $30.50 Part-D Basic Premium that is 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 BMC HealthNet Plan 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 $30.50 . 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.
BMC HealthNet Plan 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 BMC HealthNet Plan plan does not offer additional coverage through the gap.
Premium Assistance
The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The WellSense Medicare Advantage (HMO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $7.60 for 75% low income subsidy $15.20 for 50% and $22.90 for 25%.
| Full LIS Premium: | $0.00 |
|---|---|
| 75% LIS Premium: | $7.60 |
| 50% LIS Premium: | $15.20 |
| 25% LIS Premium: | $22.90 |
H6851-001 Formulary or Drug Coverage
WellSense Medicare Advantage (HMO) 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 WellSense Medicare Advantage (HMO) H6851-001 Formulary here.
| Drug Tier | Copay Preferred Pharmacy |
Copay Nonpreferred Pharmacy |
|---|---|---|
| Tier 1 | NA | 25% |
Coverage Area for WellSense Medicare Advantage (HMO)
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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.