2019 WellCare Premier (PPO) H0270-1-0 in AR from Universal American | HealthPocket

WellCare Premier (PPO)

$0/mo

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Zip Code72209
Applicant8/23/1984 Male
Coverage Start8/24/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUniversal American
Plan IDH0270-1-0
Plan Year2019
CMS RatingNot Rated
Plan TypePPO
Annual Deductible$150.00

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)$10,000 In and Out-of-network
$6,700 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$285 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:50% per day for days 1 and beyond
Outpatient hospital coverageIn-Network:$225-350 per visit
Out-of-Network:50% per visit
Doctor visitsPrimary:
In-Network:$5 per visit
Out-of-Network:50% per visit
Specialist:
In-Network:$45 per visit
Out-of-Network:50% per visit
Preventive careIn-Network:$0 copay
Out-of-Network:$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$45 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:$0-275
Out-of-Network:50%
Lab services:
In-Network:$0 copay
Out-of-Network:$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:$0-275
Out-of-Network:50%
Outpatient x-rays:
In-Network:$80
Out-of-Network:50%
Mental health servicesInpatient hospital - psychiatric:
In-Network:$300 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:50% per day for days 1 through 90
Outpatient group therapy visit with a psychiatrist:
In-Network:$40
Out-of-Network:50%
Outpatient individual therapy visit with a psychiatrist:
In-Network:$40
Out-of-Network:50%
Outpatient group therapy visit:
In-Network:$40
Out-of-Network:50%
Outpatient individual therapy visit:
In-Network:$40
Out-of-Network:50%
Skilled Nursing FacilityIn-Network:$0 per day for days 1 through 20
$172 per day for days 21 through 100
Out-of-Network:$0 per day for days 1 through 20
$172 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:
In-Network:$40
Out-of-Network:50%
Physical therapy and speech and language therapy visit:
In-Network:$40
Out-of-Network:50%
Ground ambulanceIn-Network:$325
Out-of-Network:50%
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:$45
Out-of-Network:50%
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:20% per item
Out-of-Network:20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:20% per item
Out-of-Network:20% per item
Diabetes supplies:
In-Network:$0 per item
Out-of-Network:$0 or 20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:20%
Out-of-Network:50%
Other Part B drugs:
In-Network:20%
Out-of-Network:50%

Benefits Services

Hearing
Hearing examIn-Network: $45
Out-of-Network: $0 or 50%
Fitting/evaluationIn-Network: $0 copay
Out-of-Network: $0 or 50%
There may be limits on how much the plan will provide.
Hearing aidsIn-Network: $699-999
Out-of-Network: $699-999
There may be limits on how much the plan will provide.
Preventive Dental
Oral examIn-Network: $0 copay
Out-of-Network: 20-40%
There may be limits on how much the plan will provide.
CleaningIn-Network: $0 copay
Out-of-Network: 20-40%
There may be limits on how much the plan will provide.
Fluoride treatmentIn-Network: $0 copay
Out-of-Network: 20-40%
There may be limits on how much the plan will provide.
Dental x-ray(s)In-Network: $0 copay
Out-of-Network: 20-40%
There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesIn-Network: $0
Out-of-Network: 20-40%
There may be limits on how much the plan will provide.
EndodonticsNot covered
PeriodonticsIn-Network: 20%
Out-of-Network: 20-40%
There may be limits on how much the plan will provide.
ExtractionsIn-Network: 20%
Out-of-Network: 20-40%
There may be limits on how much the plan will provide.
Prosthodontics, other oral/maxillofacial surgery, other servicesIn-Network: 20%
Out-of-Network: 20-40%
There may be limits on how much the plan will provide.
Vision
Routine eye examIn-Network: $0 copay
Out-of-Network: $0 or 50%
There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesIn-Network: $0 copay
Out-of-Network: $0 or 50%
There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)In-Network: $0 copay
Out-of-Network: $0 or 50%
There may be limits on how much the plan will provide.
Eyeglass framesIn-Network: $0 copay
Out-of-Network: $0 or 50%
There may be limits on how much the plan will provide.
Eyeglass lensesIn-Network: $0 copay
Out-of-Network: $0 or 50%
There may be limits on how much the plan will provide.
UpgradesNot covered

Coverage Area for WellCare Premier (PPO)

StateArkansas
CountyPulaski

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$7 copay$7 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 offered30% coinsurance30% 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$21 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 Premier (PPO) for Arkansas

get free advice

Speak With A Licensed Agent

Call (800) 931-6467

Learn More

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. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

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. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)