WellCare Choice (HMO-POS)

Medicare Advantage Plan for Illinois

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderWellCare
Plan IDH1416-24-0
CMS Rating1
Plan TypeHMO-POS
Annual Deductible$0.00

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

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$3,400 In and Out-of-network $3,400 In-network $3,400 Out-of-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$64.00

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$350 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
30% per stay
Outpatient hospital coverage
In-Network:
$150 per visit
Out-of-Network:
30% per visit
Doctor visits
Primary:
In-Network:
$0 copay
Out-of-Network:
30% per visit
Specialist:
In-Network:
$25 per visit
Out-of-Network:
30% per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
30%
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$25 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$0-50
Out-of-Network:
30%
Lab services:
In-Network:
$0 copay
Out-of-Network:
30%
Diagnostic radiology services (e.g., MRI):
In-Network:
20%
Out-of-Network:
30%
Outpatient x-rays:
In-Network:
$0
Out-of-Network:
30%
Mental health services
In-Network:
$300 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
30% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
30%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
30%
Outpatient group therapy visit:
In-Network:
$40
Out-of-Network:
30%
Outpatient individual therapy visit:
In-Network:
$40
Out-of-Network:
30%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$164.50 for days 21 through 100
Out-of-Network:
30% per stay
Rehabilitation services
Occupational therapy visit:
In-Network:
$25
Out-of-Network:
30%
Physical therapy and speech and language therapy visit:
In-Network:
$25
Out-of-Network:
30%
Ambulance
In-Network:
$200
Out-of-Network:
30%
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$25
Out-of-Network:
30%
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
30% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
30% per item
Diabetes supplies:
In-Network:
$0 per item
Out-of-Network:
30% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
30%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
30%

Coverage Area for WellCare Choice (HMO-POS)

StateIllinois
CountyCook

Cost Sharing Information

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 offered48% coinsurance48% coinsurance
Tier 5: Specialty TierNot offered33% coinsurance33% 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$25 copay
Tier 3: Preferred Brand NameNot offered$141 copay$117.5 copay
Tier 4: Non-Preferred Brand NameNot offered48% coinsurance48% coinsurance
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

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

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Not Rated
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept WellCare Choice (HMO-POS) for Illinois

/
KARPINSKI, ALINA
2701 W 68TH ST
CHICAGO, IL 60629
CHRISTOU, THEODORE
5525 S PULASKI RD
CHICAGO, IL 60629
ULASZEK, DAVID
5525 S PULASKI RD
CHICAGO, IL 60629
AGRAWAL, SHRI
2701 W 68TH ST
CHICAGO, IL 60629
ATASSI, MOHAMAD
6625 S PULASKI RD
CHICAGO, IL 60629
GIBSON, MELINDA
2701 W 68TH ST
CHICAGO, IL 60629
ANGARITA, LUIS
4007 W 63RD ST
CHICAGO, IL 60629
MIRSHED, NAYEH
4255 W 63RD STREET
CHICAGO, IL 60629
MCDONNELL, MICHAEL
5525 S PULASKI RD
CHICAGO, IL 60629
HUSSEINI, AMER
6625 S PULASKI RD
CHICAGO, IL 60629
OLAYA, PRISCO
6222 S PULASKI RD
CHICAGO, IL 60629
GAMARRA, NANCY
3229-43 W 47TH PL
CHICAGO, IL 60632
GARCIA, BERNADINO
5101 S KILDARE AVE
CHICAGO, IL 60632
MATHEW, A.
4455 S KEDZIE AVE
CHICAGO, IL 60632
CAVENS, PAULA
3229 W 47TH PL
CHICAGO, IL 60632
WAZWAZ, HESHAM
10448 S PULASKI RD
OAK LAWN, IL 60453
SEVANDAL, SIMEON
3339 W 55TH ST
CHICAGO, IL 60632
GARCIA, ROBYN
5101 S KILDARE AVE
CHICAGO, IL 60632
NEMICKAS, VIDAS
7722 S KEDZIE AVE
CHICAGO, IL 60652
RUPANI, PREM
6224 S ASHLAND AVE
CHICAGO, IL 60636
AKERE, AYOADE
5500 S DAMEN AVE
CHICAGO, IL 60636
TRABADO, MARCELO
1608 W 69TH ST
CHICAGO, IL 60636
OHATA, CYNTHIA
4140 SOUTHWEST HWY
HOMETOWN, IL 60456
LEWIS, BERRY
2800 W 95TH ST
EVERGREEN PARK, IL 60805
QUINN, THOMAS
2850 W 95TH ST
EVERGREEN PARK, IL 60805
Details
ALINA KARPINSKI, MD
Phone Number
(773) 434-4040
Office Locations
2701 W 68TH ST
CHICAGO, IL 60629
2701 W 68TH ST CHICAGO IL, 60629

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