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2023 Wellcare Ohana Patriot Giveback Open (PPO)

Wellcare Ohana Patriot Giveback Open (PPO) H6605-002 is a 2023 Medicare Advantage Plan or Part-C by Wellcare by ?Ohana Health Plan available to residents in Hawaii. This plan does not provide extra prescription drug (Part-D) coverage. Wellcare by ?Ohana Health Plan Wellcare Ohana Patriot Giveback Open (PPO) has a monthly premium of $0 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 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 Patriot Giveback 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.



2023 Wellcare by ?Ohana Health Plan Medicare Advantage Plan Overview

Name:Wellcare Ohana Patriot Giveback Open (PPO)
Plan ID:H6605 002 0
Provider:Wellcare by ?Ohana Health Plan
Year:2023
Type:Local PPO *
Combined Premium (C+D):$0/mo
MOOP:$7,550/yr
Similar Plan: H6605-003




What type of plan is Wellcare Ohana Patriot Giveback Open (PPO)

Wellcare Ohana Patriot Giveback 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 Patriot Giveback Open (PPO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Wellcare by ?Ohana Health Plan charges a $0 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.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Wellcare Ohana Patriot Giveback Open (PPO) by Wellcare by ?Ohana Health Plan MOOP is $7,550. Once you spend $7,550 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.





2023 Summary of Benefits


The benefit information provided is a summary of what Wellcare Ohana Patriot Giveback 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.

Wellness programs (e.g., fitness, nursing hotline)Covered


Contact lenses


In-Network Vision$0 copay
Out-of-Network Vision40% coinsurance


Eyeglass frames


Out-of-Network Vision40% coinsurance
In-Network Vision$0 copay


Eyeglass lenses


Out-of-Network Vision40% coinsurance
In-Network Vision$0 copay


Eyeglasses (frames and lenses)


Out-of-Network Vision40% coinsurance
In-Network Vision$0 copay


Other


VisionNot covered


Routine eye exam


Out-of-Network Vision40% coinsurance
In-Network Vision$0 copay


Upgrades


Out-of-Network Vision40% coinsurance
In-Network Vision$0 copay



TransportationNot covered
In-Network Skilled Nursing Facility$0 per day for days 1 through 20
$175 per day for days 21 through 70
$0 per day for days 71 through 100
Out-of-Network Skilled Nursing Facility20% per day for days 1 through 100


Occupational therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services40% coinsurance


Physical therapy and speech and language therapy visit


Out-of-Network Rehabilitation services40% coinsurance
In-Network Rehabilitation services$40 copay


Cleaning


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental70% coinsurance


Dental x-ray(s)


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental70% coinsurance


Fluoride treatment


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental70% coinsurance


Oral exam


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental70% coinsurance



In-Network Preventive care$0 copay
Out-of-Network Preventive care$0 copay
In-Network Outpatient hospital coverage$400 copay per visit
Out-of-Network Outpatient hospital coverage40% coinsurance per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo


Inpatient hospital - psychiatric


In-Network Mental health services$350 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network Mental health services20% per day for days 1 through 90


Outpatient group therapy visit


In-Network Mental health services$25 copay
Out-of-Network Mental health services40% coinsurance


Outpatient group therapy visit with a psychiatrist


In-Network Mental health services$25 copay
Out-of-Network Mental health services40% coinsurance


Outpatient individual therapy visit


Out-of-Network Mental health services40% coinsurance
In-Network Mental health services$25 copay


Outpatient individual therapy visit with a psychiatrist


In-Network Mental health services$25 copay
Out-of-Network Mental health services40% coinsurance


Chemotherapy


Out-of-Network Medicare Part B drugs40% coinsurance
In-Network Medicare Part B drugs20% coinsurance


Other Part B drugs


Out-of-Network Medicare Part B drugs40% coinsurance
In-Network Medicare Part B drugs20% coinsurance


Diabetes supplies


In-Network Medical equipment/supplies$0 copay per item
Out-of-Network Medical equipment/supplies40% coinsurance per item


Durable medical equipment (e.g., wheelchairs, oxygen)


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies40% coinsurance per item


Prosthetics (e.g., braces, artificial limbs)


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies40% coinsurance per item



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network
$7,550 In-network
Out-of-Network Inpatient hospital coverage20% per day for days 1 through 90
In-Network Inpatient hospital coverage$400 per day for days 1 through 5
$0 per day for days 6 through 90


Fitting/evaluation


In-Network Hearing$0 copay
Out-of-Network Hearing40% coinsurance


Hearing aids


In-Network Hearing$0 copay
Out-of-Network Hearing40% coinsurance


Hearing exam


Out-of-Network Hearing40% coinsurance
In-Network Hearing$50 copay



Health plan deductible$0
In-Network Ground ambulance$265 copay
Out-of-Network Ground ambulance$265 copay


Foot exams and treatment


In-Network Foot care (podiatry services)$50 copay
Out-of-Network Foot care (podiatry services)40% coinsurance


Routine foot care


Foot care (podiatry services)Not covered


Emergency


Emergency care/Urgent care$95 copay per visit (always covered)


Urgent care


Emergency care/Urgent care$40 copay per visit (always covered)


Primary


In-Network Doctor visits$5 copay per visit
Out-of-Network Doctor visits40% coinsurance per visit


Specialist


Out-of-Network Doctor visits40% coinsurance per visit
In-Network Doctor visits$50 copay per visit


Diagnostic radiology services (e.g., MRI)


In-Network Diagnostic procedures/lab services/imaging$0-400 copay
Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance


Diagnostic tests and procedures


Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0-40 copay


Lab services


Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0 copay


Outpatient x-rays


In-Network Diagnostic procedures/lab services/imaging$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance


Diagnostic services


In-Network Comprehensive dental40% coinsurance
Out-of-Network Comprehensive dental70% coinsurance


Endodontics


In-Network Comprehensive dental40% coinsurance
Out-of-Network Comprehensive dental70% coinsurance


Extractions


In-Network Comprehensive dental40% coinsurance
Out-of-Network Comprehensive dental70% coinsurance


Non-routine services


Out-of-Network Comprehensive dental70% coinsurance
In-Network Comprehensive dental40% coinsurance


Periodontics


Out-of-Network Comprehensive dental70% coinsurance
In-Network Comprehensive dental40% coinsurance


Prosthodontics, other oral/maxillofacial surgery, other services


In-Network Comprehensive dental40% coinsurance
Out-of-Network Comprehensive dental70% coinsurance


Restorative services


Out-of-Network Comprehensive dental70% coinsurance
In-Network Comprehensive dental40% 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 Patriot Giveback Open (PPO) requires you to live in that plan’s service area. The service area is listed below:

State: Hawaii Medicare
County:Hawaii County MA Plans

Honolulu County MA Plans

Kauai County MA Plans

Maui County MA Plans



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How much does Wellcare Ohana Patriot Giveback Open (PPO) cost?

Wellcare by ?Ohana Health Plan charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers 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 Patriot Giveback Open (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Wellcare Ohana Patriot Giveback Open (PPO) by Wellcare by ?Ohana Health Plan MOOP is $7,550. Once you spend $7,550 you will pay nothing for Part A or Part B covered services.

What type of plan is Wellcare Ohana Patriot Giveback Open (PPO)?

Wellcare Ohana Patriot Giveback 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.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

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.

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