2023 Wellcare Patriot Giveback Open (PPO)

Wellcare Patriot Giveback Open (PPO) H8553-002 is a 2023 Medicare Advantage Plan or Part-C by Wellcare available to residents in Arizona. This plan does not provide extra prescription drug (Part-D) coverage. Wellcare Wellcare Patriot Giveback Open (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,400 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $4,400 out-of-pocket. This can be an extremely nice safety net.

Wellcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Wellcare 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 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 except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Arizona.

Jump to:

Benefits
Monthly Costs
MOOP
Coverage Area

2023 Wellcare Medicare Advantage Plan Overview

Name:	Wellcare Patriot Giveback Open (PPO)
Plan ID:	H8553 002 0
Provider:	Wellcare
Year:	2023
Type:	Local PPO *
Combined Premium (C+D):	$0/mo
MOOP:	$4,400/yr
Similar Plan:	H8553-001

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

Wellcare 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 Patriot Giveback Open (PPO) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Wellcare 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 Patriot Giveback Open (PPO) by Wellcare MOOP is $4,400. Once you spend $4,400 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 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 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 Vision	40% coinsurance

Eyeglass frames

In-Network Vision	$0 copay
Out-of-Network Vision	40% coinsurance

Eyeglass lenses

In-Network Vision	$0 copay
Out-of-Network Vision	40% coinsurance

Eyeglasses (frames and lenses)

In-Network Vision	$0 copay
Out-of-Network Vision	40% coinsurance

Other

Vision	Not covered

Routine eye exam

In-Network Vision	$0 copay
Out-of-Network Vision	40% coinsurance

Upgrades

In-Network Vision	$0 copay
Out-of-Network Vision	40% coinsurance

Out-of-Network Transportation	75% coinsurance
In-Network Transportation	$0 copay
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 50 $0 per day for days 51 through 100
Out-of-Network Skilled Nursing Facility	20% per day for days 1 through 100

Occupational therapy visit

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

Physical therapy and speech and language therapy visit

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

Cleaning

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	50% coinsurance

Dental x-ray(s)

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	50% coinsurance

Fluoride treatment

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	50% coinsurance

Oral exam

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	50% coinsurance

Out-of-Network Preventive care	$0 copay
In-Network Preventive care	$0 copay
Out-of-Network Outpatient hospital coverage	40% coinsurance per visit
In-Network Outpatient hospital coverage	$200 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

Inpatient hospital - psychiatric

In-Network Mental health services	$225 per day for days 1 through 5 $0 per day for days 6 through 90
Out-of-Network Mental health services	40% per day for days 1 through 90

Outpatient group therapy visit

In-Network Mental health services	$25 copay
Out-of-Network Mental health services	40% coinsurance

Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$25 copay
Out-of-Network Mental health services	40% coinsurance

Outpatient individual therapy visit

In-Network Mental health services	$25 copay
Out-of-Network Mental health services	40% coinsurance

Outpatient individual therapy visit with a psychiatrist

Out-of-Network Mental health services	40% coinsurance
In-Network Mental health services	$25 copay

Chemotherapy

Out-of-Network Medicare Part B drugs	40% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

Other Part B drugs

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	40% coinsurance

Diabetes supplies

Out-of-Network Medical equipment/supplies	40% coinsurance per item
In-Network Medical equipment/supplies	$0 copay per item

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

Out-of-Network Medical equipment/supplies	40% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

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

Out-of-Network Medical equipment/supplies	40% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$8,950 In and Out-of-network $4,400 In-network
In-Network Inpatient hospital coverage	$250 per day for days 1 through 5 $0 per day for days 6 through 90
Out-of-Network Inpatient hospital coverage	40% per day for days 1 through 90

Fitting/evaluation

Out-of-Network Hearing	40% coinsurance
In-Network Hearing	$0 copay

Hearing aids

Out-of-Network Hearing	40% coinsurance
In-Network Hearing	$0 copay

Hearing exam

In-Network Hearing	$40 copay
Out-of-Network Hearing	40% coinsurance

Health plan deductible	$0
In-Network Ground ambulance	$230 copay
Out-of-Network Ground ambulance	$335 copay

Foot exams and treatment

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

Routine foot care

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

Emergency

Emergency care/Urgent care	$110 copay per visit (always covered)

Urgent care

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

Primary

In-Network Doctor visits	$0 copay
Out-of-Network Doctor visits	40% coinsurance per visit

Specialist

Out-of-Network Doctor visits	40% coinsurance per visit
In-Network Doctor visits	$40 copay per visit

Diagnostic radiology services (e.g., MRI)

Out-of-Network Diagnostic procedures/lab services/imaging	40% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$0-200 copay

Diagnostic tests and procedures

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

Lab services

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

Outpatient x-rays

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

Diagnostic services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	50% coinsurance

Endodontics

Out-of-Network Comprehensive dental	50% coinsurance
In-Network Comprehensive dental	$0 copay

Extractions

Out-of-Network Comprehensive dental	50% coinsurance
In-Network Comprehensive dental	$0 copay

Non-routine services

Out-of-Network Comprehensive dental	50% coinsurance
In-Network Comprehensive dental	$0 copay

Periodontics

Out-of-Network Comprehensive dental	50% coinsurance
In-Network Comprehensive dental	$0 copay

Prosthodontics, other oral/maxillofacial surgery, other services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	50% coinsurance

Restorative services

Out-of-Network Comprehensive dental	50% coinsurance
In-Network Comprehensive dental	$0 copay

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 Patriot Giveback Open (PPO) requires you to live in that plan’s service area. The service area is listed below:

State:	Arizona Medicare
County:	Cochise County MA Plans Coconino County MA Plans Gila County MA Plans Graham County MA Plans La Paz County MA Plans Maricopa County MA Plans Mohave County MA Plans Pima County MA Plans Pinal County MA Plans Santa Cruz County MA Plans Yavapai County MA Plans

Go to top

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

Wellcare 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 Patriot Giveback Open (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Wellcare Patriot Giveback Open (PPO) by Wellcare MOOP is $4,400. Once you spend $4,400 you will pay nothing for Part A or Part B covered services.

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

Wellcare 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 December 03, 2022

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.