WellCare Premier (PPO)

Medicare Advantage Plan for New York

select spinner
PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderWellCare
Plan IDH0088-1-0
CMS RatingNot Rated1
Plan TypePPO
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)
$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

Service
Cost
Inpatient hospital coverage
In-Network:
Tier 1
$300 for days 1 through 5
$0 for days 6 through 90
Tier 2
$360 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
35% for days 1 through 210
Outpatient hospital coverage
In-Network:
$75-300 per visit
Out-of-Network:
35% per visit
Doctor visits
Primary:
In-Network:
$0-25 per visit
Out-of-Network:
35% per visit
Specialist:
In-Network:
$35-50 per visit
Out-of-Network:
35% per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$30 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$0-75
Out-of-Network:
35%
Lab services:
In-Network:
$0-50
Out-of-Network:
35%
Diagnostic radiology services (e.g., MRI):
In-Network:
$100-250
Out-of-Network:
35%
Outpatient x-rays:
In-Network:
$0-50
Out-of-Network:
35%
Mental health services
In-Network:
Tier 1
$324 for days 1 through 5
$0 for days 6 through 90
Tier 2
$400 for days 1 through 3
$0 for days 4 through 90
Out-of-Network:
35% for days 1 through 90
Outpatient group therapy visit with a psychiatrist:
In-Network:
$35-40
Out-of-Network:
35%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$35-40
Out-of-Network:
35%
Outpatient group therapy visit:
In-Network:
$35-40
Out-of-Network:
35%
Outpatient individual therapy visit:
In-Network:
$35-40
Out-of-Network:
35%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network:
35% for days 1 through 100
Rehabilitation services
Occupational therapy visit:
In-Network:
$35-40
Out-of-Network:
35%
Physical therapy and speech and language therapy visit:
In-Network:
$35-40
Out-of-Network:
35%
Ambulance
In-Network:
$300
Out-of-Network:
$300
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$35-50
Out-of-Network:
35%
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
35% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
35% per item
Diabetes supplies:
In-Network:
$0 per item
Out-of-Network:
35% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
35%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
35%

Coverage Area for WellCare Premier (PPO)

StateNew York
CountyKings

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$15 copay$15 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$45 copay$37.5 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

Physician Finder

Physicians that accept WellCare Premier (PPO) for New York

/
LEFEVRE, LIONEL
3101 CLARENDON RD
BROOKLYN, NY 11226
UDUEVBO, JERRY
2503 CHURCH AVE
BROOKLYN, NY 11226
SCHMIDT, MARIE
2324 BEVERLY ROAD
BROOKLYN, NY 11226
KHAN, NASRULLAH
29 NEWKIRK PLZ
BROOKLYN, NY 11226
TELLUS, FRANCOIS
3101 CLARENDON RD
BROOKLYN, NY 11226
PEREZ, WALTER
2146 BEVERLEY RD
BROOKLYN, NY 11226
ALVAREZ, ELSIE
601 E 18TH ST
BROOKLYN, NY 11226
PERVEZ, RAHILA
29 NEWKIRK PLZ
BROOKLYN, NY 11226
VALME, GERALD
1010 OCEAN AVE
BROOKLYN, NY 11226
HERARD, WILFRID
622 OCEAN AVE
BROOKLYN, NY 11226
JOHN, SABU
322 LINDEN BLVD
BROOKLYN, NY 11226
DUDDEMPUDI, NAGAMMA
1502 CATON AVE
BROOKLYN, NY 11226
LAMBERT, ANDREA
2110 ALBEMARLE TERR
BROOKLYN, NY 11226
VITAL, LOUIS
3223 CHURCH AVENUE
BROOKLYN, NY 11226
LEFEVRE, MARIE EDITH
3101 CLARENDON RD
BROOKLYN, NY 11226
JEAN-BRICE, YONEL
3119 CLARENDON RD
BROOKLYN, NY 11226
BOGINSKY, IRENE
15 OCEAN AVE
BROOKLYN, NY 11225
BUCOBO, YOLEIDA
546 EASTERN PARKWAY
BROOKLYN, NY 11225
JEAN-JEROME, KERNILDE
901 FRANKLIN AVE
BROOKLYN, NY 11225
FRIEDMAN, HOWARD
546 EASTERN PARKWAY EMPIRE CENTER
BROOKLYN, NY 11225
SIMON, HEROLD
176 FENIMORE ST
BROOKLYN, NY 11225
FISH, SVETLANA
965 NOSTRAND AVE
BROOKLYN, NY 11225
BOYCE, ROGER
1821 BEDFORD AVE
BROOKLYN, NY 11225
VALERY, EMMANUEL
86 E 49TH STREET
BROOKLYN, NY 11203
CHUBB, FITZ
546 EASTERN PARKWAY
BROOKLYN, NY 11225
Details
LIONEL LEFEVRE, M.D.
Phone Number
(718) 462-6611
Office Locations
3101 CLARENDON RD
BROOKLYN, NY 11226
3101 CLARENDON RD BROOKLYN NY, 11226

Similar Plans

PremiumPlan NameCMS Rating
from $0
HumanaChoice H5970-015 (PPO)
Details
from $0
CDPHP $0 Medicare Rx (HMO)
Details
from $0
Univera SeniorChoice Basic (HMO)
Details
from $0
BasiCare with Part D (PPO)
Details
from $0
Aetna Medicare Value Plan (PPO)
Details

Related Articles

Related Searches

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.

{}