Wellcare Patriot No Premium (HMO) H0913-020 is a 2023 Medicare Advantage Plan or Part-C by Wellcare available to residents in New Jersey. This plan does not provide extra prescription drug (Part-D) coverage. Wellcare Wellcare Patriot No Premium (HMO) 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 works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Wellcare Patriot No Premium (HMO) 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 New Jersey.

2023 Wellcare Medicare Advantage Plan Overview

What type of plan is Wellcare Patriot No Premium (HMO)

Wellcare Patriot No Premium (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 primary care physician 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 primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

How much does Wellcare Patriot No Premium (HMO) 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 No Premium (HMO) by Wellcare 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 Patriot No Premium (HMO) 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

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Contact lenses

Vision	$0 copay

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Eyeglass frames

Vision	$0 copay

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Eyeglass lenses

Vision	$0 copay

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Eyeglasses (frames and lenses)

Vision	$0 copay

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Other

Vision	Not covered

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Routine eye exam

Vision	$0 copay

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Upgrades

Vision	$0 copay

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Transportation	Not covered
Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 60 $0 per day for days 61 through 100

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Occupational therapy visit

Rehabilitation services	$40 copay

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Physical therapy and speech and language therapy visit

Rehabilitation services	$40 copay

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Cleaning

Preventive dental	$0 copay

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Dental x-ray(s)

Preventive dental	$0 copay

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Fluoride treatment

Preventive dental	$0 copay

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Oral exam

Preventive dental	$0 copay

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Preventive care	$0 copay
Outpatient hospital coverage	$150 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

Mental health services	$300 per day for days 1 through 5 $0 per day for days 6 through 90

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Outpatient group therapy visit

Mental health services	$25 copay

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Outpatient group therapy visit with a psychiatrist

Mental health services	$25 copay

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Outpatient individual therapy visit

Mental health services	$25 copay

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Outpatient individual therapy visit with a psychiatrist

Mental health services	$25 copay

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Chemotherapy

Medicare Part B drugs	20% coinsurance

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Other Part B drugs

Medicare Part B drugs	20% coinsurance

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Diabetes supplies

Medical equipment/supplies	$0 copay per item

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

Medical equipment/supplies	20% coinsurance per item

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

Medical equipment/supplies	20% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$7,550 In-network
Inpatient hospital coverage	$400 per day for days 1 through 4 $0 per day for days 5 through 90

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Fitting/evaluation

Hearing	$0 copay

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Hearing aids

Hearing	$0 copay

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Hearing exam

Hearing	$40 copay

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Health plan deductible	$0
Ground ambulance	$200 copay

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Foot exams and treatment

Foot care (podiatry services)	$40 copay

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

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

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Urgent care

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

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Primary

Doctor visits	$5 copay per visit

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Specialist

Doctor visits	$40 copay per visit

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Diagnostic radiology services (e.g., MRI)

Diagnostic procedures/lab services/imaging	$0-150 copay

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Diagnostic tests and procedures

Diagnostic procedures/lab services/imaging	$0-20 copay

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Lab services

Diagnostic procedures/lab services/imaging	$0 copay

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Outpatient x-rays

Diagnostic procedures/lab services/imaging	$0 copay

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Diagnostic services

Comprehensive dental	40% coinsurance

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Endodontics

Comprehensive dental	40% coinsurance

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Extractions

Comprehensive dental	40% coinsurance

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Non-routine services

Comprehensive dental	40% coinsurance

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Periodontics

Comprehensive dental	40% coinsurance

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Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dental	40% coinsurance

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Restorative services

Comprehensive dental	40% coinsurance

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

Wellcare Patriot No Premium (HMO) Reviews

Is Wellcare Patriot No Premium (HMO) a good plan? Wellcare Patriot No Premium (HMO) received a 3.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Wellcare Patriot No Premium Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H0913-020 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for Wellcare

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

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 No Premium (HMO) requires you to live in that plan’s service area. The service area is listed below:

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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.