Wellcare Ohana Assist Open (PPO) H6605-003 is a 2023 Medicare Advantage Plan or Part-C by Wellcare by ?Ohana Health Plan available to residents in Hawaii. This plan includes extra prescription drug (Part-D) coverage. Wellcare by ?Ohana Health Plan Wellcare Ohana Assist Open (PPO) has a monthly premium of $14.20 and has an in-network maximum out-of-pocket limit of $5,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay
$5,000 out-of-pocket. This can be an extremely nice safety net.
Wellcare by ?Ohana Health Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Wellcare Ohana Assist Open (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance)
and Part B (Medical Insurance) coverage from Wellcare by ?Ohana Health Plan and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all
the benefits of Original Medicare from Wellcare by ?Ohana Health Plan except hospice care. Original Medicare still provides you with hospice care if you sign up for
Medicare Advantage in Hawaii.
What type of plan is Wellcare Ohana Assist Open (PPO)
Wellcare Ohana Assist 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.
How much does Wellcare Ohana Assist Open (PPO) cost?
Monthly Premium
A monthly premium is the fee you pay to the plan in exchange for coverage. Wellcare by ?Ohana Health Plan charges a $14.20 consolidated premium. The Part C premium is $0 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Wellcare Ohana Assist Open (PPO) has a monthly drug premium of $14.20 and a $505.00 drug deductible. This Wellcare by ?Ohana Health Plan plan offers a $14.20 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. This Premium covers any enhanced plan benefits offered by Wellcare by ?Ohana Health Plan above and beyond the standard PDP benefits. This can include extra coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $14.20. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.
Wellcare by ?Ohana Health Plan Gap Coverage
In 2023 once you and your plan provider have spent $4660 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 extra coverage. This Wellcare by ?Ohana Health Plan plan does not offer extra coverage through the gap.
Extra Help Premium Assistance
The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The Wellcare Ohana Assist Open (PPO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $3.50 for 75% low-income subsidy $7.10 for 50% and $10.60 for 25%.
Full Assistance Premium:
$0
75% Assistance Premium:
$3.50
50% Assistance Premium:
$7.10
25% Assistance Premium:
$10.60
MOOP
The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Wellcare Ohana Assist Open (PPO) by Wellcare by ?Ohana Health Plan MOOP is $5,000. Once you spend $5,000 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.
Formulary and Drug Coverage
Wellcare Ohana Assist Open (PPO) 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.
The benefit information provided is a summary of what Wellcare Ohana Assist Open (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Wellcare by ?Ohana Health Plan helps
get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.
Prosthodontics, other oral/maxillofacial surgery, other services
In-Network Comprehensive dental
40% coinsurance
Out-of-Network Comprehensive dental
70% coinsurance
Restorative services
Out-of-Network Comprehensive dental
70% coinsurance
In-Network Comprehensive dental
40% coinsurance
In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
No
Coverage Area
(Click county or state to compare all available Advantage plans)
The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Wellcare Ohana Assist Open (PPO) requires you to live in that plan’s service area. The service area is listed below:
How much does Wellcare Ohana Assist Open (PPO) cost?
Wellcare by ?Ohana Health Plan charges a $14.20 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
How much is Wellcare Ohana Assist Open (PPO) MOOP?
The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Wellcare Ohana Assist Open (PPO) by Wellcare by ?Ohana Health Plan MOOP is $5,000. Once you spend $5,000 you will pay nothing for Part A or Part B covered services.
What type of plan is Wellcare Ohana Assist Open (PPO)?
Wellcare Ohana Assist Open (PPO) is a Local PPO. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.
Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.
Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
Site Search:
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Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.
Every year, Medicare evaluates plans based on a 5-star rating system.