D-SNP Plan Costs & Benefits

Wellcare Dual Access Open is a Preferred Provider Organization (PPO) plan. PPO plan members usually use in-network healthcare providers but can go out of network when necessary. However, visits to non-network providers could cost significantly more.

Premiums, deductibles, and copays can widely vary between plans. It is important to compare costs and apply them to your personal financial and healthcare needs.

Healthcare Service	Member Cost
Health plan deductible	$0
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$12,450 In and Out-of-network $8,300 In-network
Doctor Visits
Specialist (Out-of-Net)	40% coinsurance per visit (authorization required)
Primary (In-Network)	$0 copay
Specialist (In-Network)	$0 copay (authorization required)
Wellness programs (e.g., fitness, nursing hotline)	Covered
Preventive care	$0 copay
Mental Health Services
Inpatient hospital - psychiatric (In-Network)	$0 copay (authorization required)
Outpatient group therapy visit (In-Network)	$0 copay (authorization required)
Outpatient individual therapy visit (In-Network)	$0 copay (authorization required)
Outpatient individual therapy visit with a psychiatrist (Out-of-Net)	40% coinsurance (authorization required)
Inpatient hospital - psychiatric (Out-of-Net)	$1,660 per stay (authorization required)
Outpatient group therapy visit with a psychiatrist (Out-of-Net)	40% coinsurance (authorization required)
Outpatient individual therapy visit with a psychiatrist (In-Network)	$0 copay (authorization required)
Outpatient group therapy visit with a psychiatrist (In-Network)	$0 copay (authorization required)
Outpatient group therapy visit (Out-of-Net)	40% coinsurance (authorization required)
Rehabilitation Services
Physical therapy and speech and language therapy visit (In-Network)	$0 copay (authorization required)
Physical therapy and speech and language therapy visit (Out-of-Net)	40% coinsurance (authorization required)
Occupational therapy visit (In-Network)	$0 copay (authorization required)
Medical Equipment / Supplies
Durable medical equipment (e.g., wheelchairs, oxygen) (Out-of-Net)	20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs) (In-Network)	$0 copay (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen) (In-Network)	$0 copay (authorization required)
Diabetes supplies (In-Network)	$0 copay (authorization required)
Diabetes supplies (Out-of-Net)	20% coinsurance per item (authorization required)
Diagnostic Procedures / Lab Services / Imaging
Lab services (Out-of-Net)	40% coinsurance (authorization required)
Diagnostic tests and procedures (In-Network)	$0 copay (authorization required)
Diagnostic tests and procedures (Out-of-Net)	40% coinsurance (authorization required)
Lab services (In-Network)	$0 copay (authorization required)
Diagnostic radiology services (e.g., MRI) (Out-of-Net)	40% coinsurance (authorization required)
Outpatient x-rays (In-Network)	$0 copay (authorization required)
Diagnostic radiology services (e.g., MRI) (In-Network)	$0 copay (authorization required)
Medicare Part B Drugs
Chemotherapy (In-Network)	$0 copay (authorization required)
Other Part B drugs (In-Network)	$0 copay (authorization required)
Chemotherapy (Out-of-Net)	40% coinsurance (authorization required)
Foot Care (podiatry Services)
Foot exams and treatment (In-Network)	$0 copay (authorization required)
Foot exams and treatment (Out-of-Net)	40% coinsurance (authorization required)
Hearing
Hearing exam (In-Network)	$0 copay (authorization required)
Hearing exam (Out-of-Net)	40% coinsurance (authorization required)
Fitting/evaluation (Out-of-Net)	40% coinsurance (authorization required, limits may apply)
Hearing aids (Out-of-Net)	40% coinsurance (authorization required, limits may apply)
Hearing aids (In-Network)	$0 copay (authorization required, limits may apply)
Preventive Dental
Dental x-ray(s) (In-Network)	$0 copay (authorization required, limits may apply)
Dental x-ray(s) (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Oral exam (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Fluoride treatment (In-Network)	$0 copay (authorization required, limits may apply)
Oral exam (In-Network)	$0 copay (authorization required, limits may apply)
Fluoride treatment (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Cleaning (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Comprehensive Dental
Periodontics (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Periodontics (In-Network)	$0 copay (authorization required, limits may apply)
Extractions (In-Network)	$0 copay (authorization required, limits may apply)
Non-routine services (In-Network)	$0 copay (authorization required, limits may apply)
Diagnostic services (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Endodontics (In-Network)	$0 copay (authorization required, limits may apply)
Non-routine services (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network)	$0 copay (authorization required, limits may apply)
Restorative services (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Diagnostic services (In-Network)	$0 copay (authorization required, limits may apply)
Extractions (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Endodontics (Out-of-Net)	50% coinsurance (authorization required, limits may apply)
Vision
Upgrades (Out-of-Net)	40% coinsurance (authorization required, limits may apply)
Eyeglasses (frames and lenses) (Out-of-Net)	40% coinsurance (authorization required, limits may apply)
Contact lenses (In-Network)	$0 copay (authorization required, limits may apply)
Contact lenses (Out-of-Net)	40% coinsurance (authorization required, limits may apply)
Routine eye exam (In-Network)	$0 copay (authorization required, limits may apply)
Eyeglasses (frames and lenses) (In-Network)	$0 copay (authorization required, limits may apply)
Eyeglass lenses (Out-of-Net)	40% coinsurance (authorization required, limits may apply)
Other	Not covered
Eyeglass frames (Out-of-Net)	40% coinsurance (authorization required, limits may apply)
Routine eye exam (Out-of-Net)	40% coinsurance (authorization required, limits may apply)
Upgrades (In-Network)	$0 copay (authorization required, limits may apply)
Eyeglass lenses (In-Network)	$0 copay (authorization required, limits may apply)
Emergency Care / Urgent Care
Urgent care	$0 copay
Ground ambulance	20% coinsurance
Inpatient hospital coverage	$1,550 per stay
Outpatient hospital coverage	40% coinsurance per visit
Skilled Nursing Facility	$0 copay
Optional supplemental benefits	No

Prescription Costs & Benefits

A basic benefit Part D plan is bundled with this health plan. This simply means that Wellcare Dual Access Open covers the minimum amount required by Medicare, whereas enhanced benefit plans cover more of the overall costs and may include more benefits.

Prescription Drug Plan Premium

Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.

Prescription Drug Plan Deductible

The Medicare Part D annual deductible with this plan is $505.00. This is the amount you must pay at the pharmacy before Wellcare begins paying its share.

Prescription Drug Plan Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Wellcare Dual Access Open has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.

Medicare's 5-Star Rating Marks

The table below shows the quality ratings for this Wellcare plan. Each year Medicare rates Special Needs Plans using nine categories. We do not recommend joining a plan with an overall rating of less than 3 stars.

Do You Qualify to Join Wellcare Dual Access Open?

Unfortunately, not everyone on Medicare will qualify to join Wellcare Dual Access Open. To join a 2023 Medicare Special Needs Plan in Newport County, Rhode Island you must be eligible for both Medicare and Medicaid. To qualify for Medicare, you must be age 65 or older. People with SSDI benefits for a disability qualify after 24 months.

Rhode Island Medicaid eligibility is based on your income and assets. Here are Rhode Island's Medicaid thresholds.

People with Medicare that do not qualify to join Wellcare Dual Access Open, or another SNP plan, are encouraged to explore Medicare Advantage plans in Newport County.

Contact Wellcare

The 2023 Medicare Special Needs Plans for Newport County, Rhode Island information on this page originates from Medicare.gov, is maintained by the All Medicare team, and was last updated on February 5, 2023.