2019 WellCare Value (HMO) H6975-1-0 in AL from Universal American | HealthPocket

WellCare Value (HMO)

$0/mo

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Zip Code35215
Applicant1/22/1984 Male
Coverage Start1/23/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUniversal American
Plan IDH6975-1-0
Plan Year2019
CMS RatingNot Rated
Plan TypeHMO
Annual Deductible$250.00

What To Know About This Plan
  • This plan has health and drug coverage

Why We Like This Plan
  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$6,700 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverage$350 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage$250 per visit
Doctor visitsPrimary:$10 per visit
Specialist:$40 per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$40 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:$0-50
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$0-50
Outpatient x-rays:$15
Mental health servicesInpatient hospital - psychiatric:$215 per day for days 1 through 7
$0 per day for days 8 through 90
Outpatient group therapy visit with a psychiatrist:$40
Outpatient individual therapy visit with a psychiatrist:$40
Outpatient group therapy visit:$40
Outpatient individual therapy visit:$40
Skilled Nursing Facility$0 per day for days 1 through 20
$172 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:$40
Physical therapy and speech and language therapy visit:$40
Ground ambulance$225
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:$40
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:20%
Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam$40
Fitting/evaluationNot covered
Hearing aids - inner earNot covered
Hearing aids - outer earNot covered
Hearing aids - over the earNot covered
Preventive Dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-ray(s)Not covered
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye examNot covered
OtherNot covered
Contact lensesNot covered
Eyeglasses (frames and lenses)Not covered
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for WellCare Value (HMO)

StateAlabama
CountyJefferson

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds$0 copay$0 copay
Tier 2: Non-Preferred GenericNot offered$10 copay$10 copay
Tier 3: Preferred Brand NameNot offered$47 copay$47 copay
Tier 4: Non-Preferred Brand NameNot offered$99 copay$99 copay
Tier 5: Specialty TierNot offered28% coinsurance28% coinsurance

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copay$0 copay
Tier 2: Non-Preferred GenericNot offered$30 copay$0 copay
Tier 3: Preferred Brand NameNot offered$141 copay$94 copay
Tier 4: Non-Preferred Brand NameNot offered$297 copay$198 copay
Tier 5: Specialty Tier

Physicians that accept WellCare Value (HMO) for Alabama

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Call (800) 931-6467

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.