Wellpoint Extra Help (HMO) 2025 Plan Details for Macon County, Tennessee Residents
Wellpoint Extra Help (HMO) 2025 Plan Details for Macon County, Tennessee Residents
Choosing the right Medicare Advantage plan in Macon County is crucial for your healthcare needs in 2025. With Wellpoint Extra Help (HMO) as one of the options, you can compare it side-by-side with other available plans to find the best fit. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
Wellpoint Extra Help Overview
Plan ID H5828-008-0 Overview | |
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Health Plan ID: | H5828-008-0 |
Medicare Advantage Plan Type: | Local HMO |
Plan Year: | 2024 |
Monthly Premium: | $8.60 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $4,900 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $545.00 deductible |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | Macon County, TN |
Insured By: | Amerigroup Community Care |
Why Consider Wellpoint Extra Help?
Wellpoint Extra Help is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that delivers comprehensive healthcare benefits. With a monthly premium of $8.60, it covers the core services of Medicare Part A and Part B, along with additional benefits like prescription drug coverage. The annual Part D deductible is $545.00. As an HMO plan, you’ll generally need to use providers within the plan’s network, except in emergencies.
A key benefit of Wellpoint Extra Help is the financial protection it offers, with an annual maximum out-of-pocket (MOOP) limit of $4,900. After reaching this limit, the plan covers 100% of your in-network healthcare costs for the rest of the year. This makes Wellpoint Extra Help a dependable option for those seeking a combination of medical and prescription drug coverage with predictable out-of-pocket expenses.
We're Here to Help You Enroll |
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Out-of-Pocket Expenses
With Wellpoint Extra Help, you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H5828-008-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 Copay |
Specialist: | $25 Copay Prior Authorization Required |
Wellness & Preventive Programs: | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $25 Copay Prior Authorization Required |
Routine Foot Care: | $0 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: | $90 Copay |
Urgent care: | $35 Copay |
Ground ambulance: | $235 Copay |
Inpatient hospital care: | $295.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
Outpatient hospital care: | $200 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $25 Copay |
Outpatient group therapy: | $25 Copay |
Inpatient psychiatric hospital care: | $260.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
Outpatient group therapy: | $25 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $25 Copay Prior Authorization Required |
Occupational therapy: | $25 Copay Prior Authorization Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | $0 Copay |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $200 Copay Prior Authorization Required |
Lab services: | $10 Copay Prior Authorization Required |
Outpatient x-rays: | $90 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $90 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 Wellpoint Extra Help as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Amerigroup Community Care 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: | $250.00 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
Wellpoint Extra Help 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: | $8.60 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $8.60 |
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 $545.00. You must pay this amount at the pharmacy before Amerigroup Community Care begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Wellpoint Extra Help 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) | $10.00 copay | $10.00 copay |
2 (Generic) | $20.00 copay | $20.00 copay |
3 (Preferred Brand) | $37.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $90.00 copay | $100.00 copay |
5 (Specialty Tier) | 25% | 25% |
6 (Select Care Drugs) | $10.00 copay | $10.00 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 |
Am I Eligible for Wellpoint Extra Help?
You are eligible to enroll in Wellpoint Extra Help if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
- You do not have End-Stage Renal Disease (ESRD), with some exceptions.
If these criteria describe your situation, you’re eligible to sign up for Wellpoint Extra Help and take advantage of its full range of benefits.
When Can I Enroll in Wellpoint Extra Help?
Knowing when you can enroll in Wellpoint Extra Help is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) for expert guidance from a licensed insurance agent.
How to Sign Up for Wellpoint Extra Help
Enrolling in Wellpoint Extra Help 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 Wellpoint Extra Help through the official Medicare website.
- Directly with Wellpoint Extra Help: 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 Amerigroup Community Care
Website: | https://shop.amerigroup.com/medicare |
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Formulary: | https://shop.amerigroup.com/medicare |
Pharmacy: | Amerigroup Community Care Pharmacy Page |
New Members: | (855)679-0560 |
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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