2020 WellCare Premier (PPO) H0270-1-0 in AR from Universal American | HealthPocket

WellCare Premier (PPO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUniversal American
Plan IDH0270-1-0
Plan Year2020
CMS RatingNot Rated
Plan TypePPO
Annual Deductible$150.00
Out-of-Pocket Maximum6700

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

Overview

Premium
Total monthly premium$0.00
Health plan premium$0.00
Drug plan premium$0.00
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductible$0
Drug plan deductible$150.00
Estimated yearly costs
Estimated total yearly costs for care$4,230.00
Out-of-pocket max
Out-of-pocket max$10,000 In and Out-of-network
$6,700 In-network

Benefits & costs

Doctor services
Primary doctor visitIn-network: $0 copay
Out-of-network: 50% per visit
Specialist visitIn-network: $45 per visit
Out-of-network: 50% per visit
Tests, labs, & imaging
Diagnostic tests & proceduresIn-network: $0-275
Out-of-network: 50%
Lab servicesIn-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)In-network: $0-275
Out-of-network: 50%
Outpatient x-raysIn-network: $80
Out-of-network: 50%
Emergency care$90 per visit (always covered)
Urgent care$45 per visit (always covered)
Hospital services
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 through 120
Outpatient hospital coverageIn-network: $225-350 per visit
Out-of-network: 50% per visit
Skilled nursing facility
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
Preventive services
Preventive servicesIn-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulanceIn-network: $325
Out-of-network: 50%
Therapy services
Occupational therapy visitIn-network: $40
Out-of-network: 50%
Physical therapy & speech & language therapy visitIn-network: $40
Out-of-network: 50%
Mental health services
Outpatient group therapy with a psychiatristIn-network: $40
Out-of-network: 50%
Outpatient individual therapy with a psychiatristIn-network: $40
Out-of-network: 50%
Outpatient group therapy visitIn-network: $40
Out-of-network: 50%
Outpatient individual therapy visitIn-network: $40
Out-of-network: 50%
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)In-network: 20% per item
Out-of-network: 20% per item
Prosthetics (like braces, artificial limbs)In-network: 20% per item
Out-of-network: 20% per item
Diabetes suppliesIn-network: $0 per item
Out-of-network: $0 or 20% per item

Extra benefits & costs

Hearing
Hearing examIn-network: $45
Out-of-network: 50%
Fitting/evaluationIn-network: $0 copay
Out-of-network: $0-999
Hearing aids - All typesIn-network: $699-999
Out-of-network: $0-999
Preventive dental
Oral examIn-network: $0 copay
Out-of-network: 20-40%
CleaningIn-network: $0 copay
Out-of-network: 20-40%
Fluoride treatmentIn-network: $0 copay
Out-of-network: 20-40%
Dental x-raysIn-network: $0 copay
Out-of-network: 20-40%
Comprehensive dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesIn-network: $0
Out-of-network: 20-40%
EndodonticsNot covered
PeriodonticsIn-network: 20%
Out-of-network: 20-40%
ExtractionsIn-network: 20%
Out-of-network: 20-40%
Prosthodontics, other oral/maxillofacial surgery, other servicesIn-network: 20%
Out-of-network: 20-40%
Vision
Routine eye examIn-network: $0 copay
Out-of-network: 50%
Contact lensesIn-network: $0 copay
Out-of-network: 50%
Eyeglasses (frames & lenses)In-network: $0 copay
Out-of-network: 50%
Eyeglass frames (only)In-network: $0 copay
Out-of-network: 50%
Eyeglass lenses (only)In-network: $0 copay
Out-of-network: 50%
UpgradesNot covered
More benefits
Fitness benefitLimited coverage
Over the counter drug benefitsLimited coverage
In-home support servicesNot covered
Home and bathroom safety devicesNot covered
Meals for short durationLimited coverage
Annual physical examsLimited coverage
TelehealthNot covered

Drug coverage & costs

Part B drugs
Chemotherapy drugsIn-network: 20%
Out-of-network: 50%
Other Part B drugsIn-network: 20%
Out-of-network: 50%

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 Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$0 copay$0 copay$0 copay
Tier 2: Non-Preferred GenericNot offereds$7 copay$7 copay$7 copay
Tier 3: Preferred Brand NameNot offereds$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Brand NameNot offereds$99 copay$99 copay$99 copay
Tier 5: Specialty TierNot offereds30% coinsurance30% coinsurance30% coinsurance
Tier 6: Select Care Drugs

90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$0 copay$0 copay$0 copay
Tier 2: Non-Preferred GenericNot offereds$21 copay$0 copay$21 copay
Tier 3: Preferred Brand NameNot offereds$141 copay$94 copay$141 copay
Tier 4: Non-Preferred Brand NameNot offereds$297 copay$198 copay$297 copay
Tier 5: Specialty Tier
Tier 6: Select Care Drugs

Staying healthy - screenings, tests and vaccines

Breast cancer screeningNot Rated
Colorectal cancer screeningNot Rated
Annual flu vaccineNot Rated
Improving or maintaining physical healthNot Rated
Improving or maintaining mental healthNot Rated
Monitoring physical abilityNot Rated
Adult BMI assessmentNot Rated

Managing Chronic Conditions

Special needs plan care managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain assessmentNot Rated
Osteoporosis management in women who had a fractureNot Rated
Diabetes care – eye examNot Rated
Diabetes care – kidney disease monitoringNot Rated
Diabetes care – blood sugar controlledNot Rated
Rheumatoid arthritis managementNot Rated
Reducing the risk of fallingNot Rated
Improving bladder controlNot Rated
Medication reconciliation post-dischargeNot Rated
Plan all-cause readmissionsNot Rated
Statin Therapy for Patients with Cardiovascular DiseaseNot Rated

Member Experience with Health Plan

Getting needed careNot Rated
Getting appointments and care quicklyNot Rated
Customer serviceNot Rated
Rating of health care qualityNot Rated
Rating of health planNot Rated
Care CoordinationNot Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health planNot Rated
Members choosing to leave the health planNot Rated
Health plan quality improvementNot Rated

Health Plan Customer Service

Plan makes timely decision about appealsNot Rated
Reviewing appeals decisionsNot Rated
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY availability
Appeals auto-forwardNot Rated
Appeals upheldNot Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Drug plan quality improvementNot Rated

Member Experience with Drug Plan

Rating of drug planNot Rated
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
Medication adherence for diabetes medicationsNot Rated
Medication adherence for hypertension - RAS antagonistsNot Rated
Medication adherence for cholesterol - StatinsNot Rated
MTM program completion rate for CMRNot Rated
Statin use in persons with diabetes - SUPDNot Rated

Physicians that accept WellCare Premier (PPO) for Arkansas

WellCare Preferred (HMO)
COST:from $0CMS Rating:
Select
Aetna Medicare Elite (PPO)
COST:from $0CMS Rating:
Select
AARP Medicare Advantage Plan 1 (HMO)
COST:from $0CMS Rating:
Select
Vantage BASIC (HMO-POS)
COST:from $0CMS Rating:Not Rated
Select
HumanaChoice R1532-001 (Regional PPO)
COST:from $0CMS Rating:
Select

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Medicare Plans Found

 

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family 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 part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).