Wellcare No Premium (HMO) 2025 Plan Details for Perry County, Indiana Residents
Wellcare No Premium (HMO) 2025 Plan Details for Perry County, Indiana Residents
When selecting a Medicare Advantage plan in Perry County for 2025, it's important to compare all your options. Wellcare No Premium (HMO) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
Wellcare No Premium Overview
Plan ID H3499-002-0 Overview | |
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Health Plan ID: | H3499-002-0 |
Medicare Advantage Plan Type: | Local HMO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $3,900 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $175.00 deductible |
Part D Gap Coverage: | Yes |
Supplemental Benefits: | Vision, Hearing |
Availability: | Perry County, IN |
Insured By: | Wellcare by Allwell |
Why Choose Wellcare No Premium?
Wellcare No Premium is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that provides comprehensive healthcare coverage. With a monthly premium of $0.00, this plan includes the essential benefits of Medicare Part A and Part B, as well as additional services like prescription drug coverage. The annual Part D deductible is $175.00. As an HMO plan, you’ll typically need to use providers within the plan’s network, except in emergencies.
One of the important aspects of Wellcare No Premium is its protection against high medical expenses. The annual maximum out-of-pocket (MOOP) limit is $3,900, ensuring that once this amount is reached, the plan covers 100% of your in-network healthcare costs for the rest of the year. This makes Wellcare No Premium a reliable choice for those looking for a plan that combines medical and prescription drug coverage with predictable out-of-pocket expenses.
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Out-of-Pocket Costs
Wellcare No Premium includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H3499-002-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 Copay |
Specialist: | $35 Copay Prior Authorization Required |
Wellness & Preventive Programs: | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $35 Copay Prior Authorization Required |
Routine Foot Care: | $35 Copay Prior Authorization Required |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $20 Copay Prior Authorization Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $120 Copay |
Urgent care: | $35 Copay |
Ground ambulance: | $285 Copay |
Inpatient hospital care: | $350.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
Outpatient hospital care: | $250 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 through 40 $0.00 per day for days 41 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $40 Copay |
Outpatient group therapy: | $40 Copay |
Inpatient psychiatric hospital care: | $350.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
Outpatient group therapy: | $40 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $35 Copay Prior Authorization Required |
Occupational therapy: | $35 Copay Prior Authorization Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | $0 Copay Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $350 Copay Prior Authorization Required |
Lab services: | $50 Copay Prior Authorization Required |
Outpatient x-rays: | $0 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $25 Copay Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Wellcare No Premium as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Wellcare by Allwell offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay Prior Authorization Required |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay Prior Authorization Required |
Vision | Maximum vision benefit: | $200.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay Prior Authorization Required |
Contact lenses (In-Network) | $0 Copay |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
Wellcare No Premium includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
While the prescription drug plan (Part D) premium is included in the overall plan cost, some plans may have additional costs or provide assistance through the Low-Income Subsidy (LIS) program. Also known as Extra Help, LIS is a Social Security program that assists individuals with limited income and resources in reducing or eliminating Part D expenses.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | -$5.20 |
Supplemental Part D Premium: | $5.20 |
Total Part D Premium: | $0.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $175.00. You must pay this amount at the pharmacy before Wellcare by Allwell begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Wellcare No Premium has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $0.00 copay (deductible does not apply) | $5.00 copay (deductible does not apply) |
2 (Generic) | $5.00 copay | $10.00 copay |
3 (Preferred Brand) | $42.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | 50% | 50% |
5 (Specialty Tier) | 30% | 30% |
6 (Select Care Drugs) | $0.00 copay | $0.00 copay |
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Who Can Enroll in Wellcare No Premium?
To qualify for enrollment in Wellcare No Premium, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
- Not have End-Stage Renal Disease (ESRD), except under certain conditions.
If you fulfill these criteria, you can enroll in Wellcare No Premium and enjoy the extensive healthcare benefits it offers.
When Can I Enroll in Wellcare No Premium?
Understanding the right time to enroll in Wellcare No Premium is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
Steps to Enroll in Wellcare No Premium
Enrolling in Wellcare No Premium is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Wellcare No Premium through the official Medicare website.
- Directly with Wellcare No Premium: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Contact Wellcare by Allwell
Website: | http://www.wellcare.com/allwellIN |
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Formulary: | http://www.wellcare.com/allwellIN |
Pharmacy: | Wellcare by Allwell Pharmacy Page |
New Members: | (844)917-0175 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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