2019 WellCare TexanPlus Classic (HMO) H4506-003-000 in TX from Universal American | HealthPocket

WellCare TexanPlus Classic (HMO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUniversal American
Plan IDH4506-003-000
Plan Year2019
CMS Rating
Plan TypeHMO
Annual Deductible$0.00
Out-of-Pocket Maximum3400

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2020. 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
  • was the 5th best selling plan in El Paso in 2020

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$3,400 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverage$250 per stay
Outpatient hospital coverage$150 per visit
Doctor visitsPrimary:$0 copay
Specialist:$35 per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:$120 per visit (always covered)
Urgent care:$25 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:$0-25
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$0 or 10%
Outpatient x-rays:$0
Mental health servicesInpatient hospital - psychiatric:$325 per stay
Outpatient group therapy visit with a psychiatrist:$20
Outpatient individual therapy visit with a psychiatrist:$20
Outpatient group therapy visit:$20
Outpatient individual therapy visit:$20
Skilled Nursing Facility$0 per day for days 1 through 20
$100 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:$35
Physical therapy and speech and language therapy visit:$10
Ground ambulance$250
Transportation$0 copay. There may be limits on how much the plan will provide.
Foot care (podiatry services)Foot exams and treatment:$35
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):10% 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 drugsChemotherapy:10%
Other Part B drugs:$0 or 10%

Benefits Services

Hearing
Hearing exam$35
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
Office visit$5.00
Oral examCovered under office visit. There may be limits on how much the plan will provide.
CleaningCovered under office visit. There may be limits on how much the plan will provide.
Fluoride treatmentCovered under office visit. There may be limits on how much the plan will provide.
Dental x-ray(s)Covered under office visit. 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.
ExtractionsNot covered
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 TexanPlus Classic (HMO)

StateTexas
CountyEl Paso

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$5 copay$5 copay
Tier 3: Preferred Brand NameNot offereds$40 copay$40 copay
Tier 4: Non-Preferred Brand NameNot offereds$80 copay$80 copay
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$12.5 copay$0 copay
Tier 3: Preferred Brand NameNot offereds$100 copay$80 copay
Tier 4: Non-Preferred Brand NameNot offereds$200 copay$160 copay
Tier 5: Specialty Tier
Tier 6: Select Care Drugs

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 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 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 CoordinationNot Rated

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
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
Statin Use in Persons with Diabetes

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Medicare Plans Found

 

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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).