2018 WellCare Premier (PPO) H5199-3-0 in FL from Universal American | HealthPocket

WellCare Premier (PPO)

$0/mo

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Zip Code33186
Applicant7/23/1984 Male
Coverage Start7/24/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUniversal American
Plan IDH5199-3-0
Plan Year2018
CMS RatingNot Rated
Plan TypePPO
Annual Deductible$250.00

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan

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 Year2018
Optional Supplemental BenefitsNo
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network $6,700 In-network
Other health plan deductibles?No
Health Plan Deductible$0
Monthly Drug Plan Premium$0.00
Monthly Health Plan Premium$0.00

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:
$350 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
40% for days 1 through 150
Outpatient hospital coverageIn-Network:
$250-300 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:
$80 per visit (always covered)
Urgent care:
$30 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:
$0-100
Out-of-Network:
50%
Lab services:
In-Network:
$0 copay
Out-of-Network:
50%
Diagnostic radiology services (e.g., MRI):
In-Network:
$150
Out-of-Network:
50%
Outpatient x-rays:
In-Network:
$0
Out-of-Network:
50%
Mental health servicesIn-Network:
$300 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
50% 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 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network:
50% for days 1 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%
AmbulanceIn-Network:
$250
Out-of-Network:
$250
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:
50% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
50% per item
Diabetes supplies:
In-Network:
10% per item
Out-of-Network:
50% 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%

Coverage Area for WellCare Premier (PPO)

StateFlorida
CountyMiami-Dade

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$12 copay$12 copay
Tier 3: Preferred Brand NameNot offered$47 copay$47 copay
Tier 4: Non-Preferred Brand NameNot offered$100 copay$100 copay
Tier 5: Specialty TierNot offered25% coinsurance25% 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$36 copay$30 copay
Tier 3: Preferred Brand NameNot offered$141 copay$117.5 copay
Tier 4: Non-Preferred Brand NameNot offered$300 copay$250 copay
Tier 5: Specialty Tier

Physicians that accept WellCare Premier (PPO) for Florida

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Rene, Mayorga
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Margarita, Ramos-gonzalez
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Ramiro, Nieves
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Sanjay, Razdan
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Rommel, Morales
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Jose, Fernandez
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Padmaja, Yatham
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Marcos, Szomstein
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Omar, Salazar
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Kristin, Haushalter
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Eduardo, Krajewski
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Marvin, Rios
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George, Yatzkan
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Rene Mayorga, MD
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  • Phone Number
    (305) 378-1302
  • Office Locations
    14261 Sw 120th St Ste 110
    Miami, FL 33186
14261 Sw 120th St Ste 110 Miami FL, 33186
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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. 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)