2019 WellCare Value (HMO) H4868-11-2 in NY from Universal American | HealthPocket

WellCare Value (HMO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUniversal American
Plan IDH4868-11-2
Plan Year2019
CMS RatingNot Rated
Plan TypeHMO
Annual Deductible$0.00
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

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$190 In-network
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$6,700 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverage$400 per day for days 1 through 3
$0 per day for days 4 through 90
Outpatient hospital coverage20% per visit
Doctor visitsPrimary:$10 per visit
Specialist:$50 per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$25 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:$0-50
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$0-225
Outpatient x-rays:$0
Mental health servicesInpatient hospital - psychiatric:$405 per day for days 1 through 4
$0 per day 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 per day for days 1 through 20
$164.50 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:$40
Physical therapy and speech and language therapy visit:$40
Ground ambulance$200
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:$50
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:20%
Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam$50
Fitting/evaluation$0 copay. There may be limits on how much the plan will provide.
Hearing aids$0 copay. There may be limits on how much the plan will provide.
Preventive Dental
Oral exam$0 copay. There may be limits on how much the plan will provide.
Cleaning$0 copay. There may be limits on how much the plan will provide.
Fluoride treatment$0 copay. There may be limits on how much the plan will provide.
Dental x-ray(s)$0 copay. There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative services$0 copay. There may be limits on how much the plan will provide.
EndodonticsNot covered
Periodontics$0 copay. There may be limits on how much the plan will provide.
Extractions$0 copay. There may be limits on how much the plan will provide.
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay. There may be limits on how much the plan will provide.
Vision
Routine eye exam$0 copay. There may be limits on how much the plan will provide.
OtherNot covered
Contact lenses$0 copay. There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)$0 copay. There may be limits on how much the plan will provide.
Eyeglass frames$0 copay. There may be limits on how much the plan will provide.
Eyeglass lenses$0 copay. There may be limits on how much the plan will provide.
UpgradesNot covered

Coverage Area for WellCare Value (HMO)

StateNew York
CountyKings

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
Tier 2: Non-Preferred GenericNot offereds$12 copay$12 copay
Tier 3: Preferred Brand NameNot offereds$47 copay$47 copay
Tier 4: Non-Preferred Brand NameNot offereds48% coinsurance48% coinsurance
Tier 5: Specialty TierNot offereds33% coinsurance33% 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
Tier 2: Non-Preferred GenericNot offereds$36 copay$0 copay
Tier 3: Preferred Brand NameNot offereds$141 copay$94 copay
Tier 4: Non-Preferred Brand NameNot offereds48% coinsurance48% coinsurance
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 screeningNot 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
Controlling blood pressureNot Rated
Rheumatoid arthritis managementNot Rated
Reducing the risk of fallingNot Rated
Plan all-cause readmissionsNot Rated

Member Experience with Health Plan

Getting needed careNot Rated
Getting appointments and care quicklyNot Rated
Customer serviceNot Rated
Overall rating of health care qualityNot Rated
Overall rating of 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
Beneficiary access and performance problemsNot 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 - MedicalNot Rated

Drug Plan Customer Service

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

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Beneficiary access and performance problemsNot 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
High risk medicationNot Rated
Part D medication adherence for diabetesNot Rated
Part D medication adherence for hypertensionNot Rated
Part D medication adherence for cholesterolNot Rated
Medication Therapy Management program completion rateNot Rated
Statin Use in Persons with DiabetesNot Rated

Physicians that accept WellCare Value (HMO) for New York

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Louis, Vital
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Walter, Perez
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Victor, Sharobeem
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Rubin Brecher Md Llc
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Nicola, Jacobucci
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Fred, Montas
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David, Sussman
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David, Kessler
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Albina, Chua
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Erroll, Byer
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Franck, Leveille
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South Elliot South Portland Medical Comprehensive Medical Center
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Cary, English
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Theodore, Avruskin
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Rajiv, Saini
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Herman, Rosenberg
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Olanrewaju, Adeosun
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James, Einhorn
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Ali, Zaidi
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Kathy, Man-wong
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George, Martin
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Barbara, Haralson
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Jeffrey, Shoub
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Michael, Banker
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Mikhail, Grabovetsky
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Louis Vital, MD
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  • Phone Number
    (718) 693-4900
  • Office Locations
    3223 Church Avenue
    Brooklyn, NY 11226
3223 Church Avenue Brooklyn NY, 11226
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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).

Medicare Plans Found

 

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).