WellCare Value (HMO)

Medicare Advantage Plan for New Jersey

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderWellCare
Plan IDH0913-12-0
CMS Rating1
Plan TypeHMO
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

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)
$6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$18.90
Monthly Health Plan Premium
$1.10

Benefits

Service
Cost
Inpatient hospital coverage
$330 for days 1 through 4
$0 for days 5 through 90
Outpatient hospital coverage
$250 or 20% per visit
Doctor visits
Primary:$10 per visit
Specialist:$40 per visit
Preventive care
$0 copay
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:$0-50
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):20%
Outpatient x-rays:$0
Mental health services
$400 for days 1 through 4
$0 for days 5 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 for days 1 through 20
$164.50 for days 21 through 100
Rehabilitation services
Occupational therapy visit:$40
Physical therapy and speech and language therapy visit:$40
Ambulance
$250
Transportation
$0 copay
Foot care (podiatry services)
Foot exams and treatment:$40
Routine foot care:Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:$0 per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:20%
Other Part B drugs:20%

Coverage Area for WellCare Value (HMO)

StateNew Jersey
CountyOcean

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$6 copay$6 copay
Tier 2: Non-Preferred GenericNot offered$20 copay$20 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$18 copay$0 copay
Tier 2: Non-Preferred GenericNot offered$60 copay$50 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
Not Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Not Rated
Reducing the risk of falling
Not Rated
Plan all-cause readmissions
Not Rated

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Not Rated
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
Not Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Not Rated
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 Value (HMO) for New Jersey

/
LEHNES, ERIC
475 ROUTE 70 SUITE 101
LAKEWOOD, NJ 08701
UTPAT, SANDEEPA
101 PROSPECT ST
LAKEWOOD, NJ 08701
KORETZKY, JEFFREY
4618 ROUTE 9 SOUTH
HOWELL, NJ 07731
DE PERIO, ELIZABETH PINKY
4677 US HIGHWAY 9
HOWELL, NJ 07731
LIPKOWITZ, KENNETH
4618 ROUTE 9 SOUTH
HOWELL, NJ 07731
Details
ERIC LEHNES, MD
Phone Number
(732) 364-8000
Office Locations
475 ROUTE 70 SUITE 101
LAKEWOOD, NJ 08701
475 ROUTE 70 SUITE 101 LAKEWOOD NJ, 08701

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