Doctor Office Visit: Copayment for Primary Care Office Visit $0.00
Specialty Doctor Visit
In-Network:
Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0.00 Prior Authorization Required for Doctor Specialty Visit Prior authorization required
Inpatient Hospital Care
In-Network:
Acute Hospital Services: Copayment for Acute Hospital Services per Stay $0.00 Prior Authorization Required for Acute Hospital Services Prior authorization required
Urgent Care
Copayment for Urgent Care $0.00 Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours
Worldwide Coverage: Copayment for Worldwide Urgent Coverage $100.00 Maximum Plan Benefit of $50,000
Emergency Room Visit
Copayment for Emergency Care $0.00 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours
Worldwide Coverage: Copayment for Worldwide Emergency Coverage $100.00 Maximum Plan Benefit of $50,000
Ambulance Transportation
In-Network:
Ground Ambulance: Copayment for Ground Ambulance Services $0.00
Air Ambulance: Copayment for Air Ambulance Services $0.00
Please see Evidence of Coverage for Prior Authorization rules Prior authorization required
Health Care Services and Medical Supplies
Wellcare Dual Access (HMO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
Coverage
Cost
Chiropractic Services
In-Network: Copayment for Medicare-covered Chiropractic Services $0.00 Copayment for Routine Care $0.00
Maximum 24 Routine Care every year
Prior Authorization Required for Chiropractic Services Prior authorization required
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network: Copayment for Medicare-covered Diabetic Supplies $0.00 Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0.00 Prior Authorization Required for Diabetic Supplies and Services Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage) Prior authorization required
Durable Medical Eqipment (DME)
In-Network: Copayment for Medicare-covered Durable Medical Equipment $0.00 Prior Authorization Required for Durable Medical Equipment Prior authorization required
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:
Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0.00 Copayment for Medicare-covered Lab Services $0.00 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0.00 Copayment for Medicare-covered Therapeutic Radiological Services $0.00 Copayment for Medicare-covered X-Ray Services $0.00 Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services Prior authorization required
Home Health Care
In-Network: Copayment for Medicare-covered Home Health Services $0.00 Prior Authorization Required for Home Health Services Prior authorization required
Mental Health Inpatient Care
In-Network:
Psychiatric Hospital Services: $0.00 per day for days 1 to 2 $0.00 per day for days 3 to 90 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required
Mental Health Outpatient Care
In-Network: Copayment for Medicare-covered Individual Sessions $0.00 Copayment for Medicare-covered Group Sessions $0.00 Prior Authorization Required for Outpatient Mental Health Services Prior authorization required
Outpatient Services / Surgery
In-Network:
Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0.00 Prior Authorization Required for Outpatient Hospital Services
Outpatient Observation Services: Copayment for Medicare Covered Observation Services $0.00
Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0.00 Prior Authorization Required for Ambulatory Surgical Center Services Prior authorization required
Outpatient Substance Abuse Care
In-Network: Copayment for Medicare-covered Individual Sessions $0.00 Copayment for Medicare-covered Group Sessions $0.00 Prior Authorization Required for Outpatient Substance Abuse Services Prior authorization required
Over-the-counter (OTC) Items
In-Network:
Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0.00 Maximum Plan Benefit of $150.00 every month Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit
Podiatry Services
In-Network: Copayment for Medicare-Covered Podiatry Services $0.00 Prior Authorization Required for Podiatry Services Prior authorization required
Skilled Nursing Facility Care
In-Network:
Skilled Nursing Facility Services: $0.00 per day for days 1 to 20 $0.00 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services Prior authorization required
Dental Benefits
The following dental services are covered from in-network providers.
Coverage
Cost
Dental Care
In-Network:
Preventive Dental: Copayment for Oral Exams $0.00
Maximum 2 visits every year
Copayment for Prophylaxis (Cleaning) $0.00
Maximum 2 visits every year
Copayment for Fluoride Treatment $0.00
Maximum 1 visit every year
Copayment for Dental X-Rays $0.00
Maximum 1 visit (Please see Evidence of Coverage for details)
Referral Required for Preventive Dental
Comprehensive Dental: Copayment for Medicare-covered Benefits $0.00 Copayment for Non-routine Services $0.00
Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Diagnostic Services $0.00
Maximum 1 visit every year
Copayment for Restorative Services $0.00
Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Endodontics $0.00
Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Periodontics $0.00
Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Extractions $0.00
Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00
Maximum 3 visits (Please see Evidence of Coverage for details)
Prior Authorization Required for Comprehensive Dental Prior authorization required
Vision Benefits
The following vision services are covered from in-network providers.
Coverage
Cost
Vision Benefits
In-Network:
Eye Exams: Copayment for Medicare Covered Benefits $0.00 Copayment for Routine Eye Exams $0.00
Maximum 1 Routine Eye Exam every year
Prior Authorization Required for Eye Exams
Eyewear: Copayment for Medicare-Covered Benefits $0.00 Maximum Plan Allowance of $400.00 every year for all Non-Medicare covered eyewear Prior Authorization Required for Eyewear Prior authorization required
Hearing Benefits
The following hearing services are covered from in-network providers.
Coverage
Cost
Hearing Benefits
In-Network:
Hearing Exams: Copayment for Medicare Covered Benefits $0.00 Copayment for Routine Hearing Exams $0.00
Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0.00
Maximum 1 visit every year
Prior Authorization Required for Hearing Exams
Hearing Aids: Copayment for Hearing Aids $0.00
Maximum 2 Hearing Aids every year
Maximum Plan Benefit of $2000.00 every year per ear Prior Authorization Required for Hearing Aids Prior authorization required
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
Coverage
Cost
Preventive Services and Health/Wellness Education Programs
In-Network: $0.00 copay for Medicare Covered Preventive Services:
Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vagin*l cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
COVID-19 shots
Flu shots
Hepatitis B shots
Pneumococcal shots
Tobacco use cessation Yearly "Wellness" visit
Prescription Drug Costs and Coverage
The Wellcare Dual Access (HMO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $0 per year.
This plan is offered exclusively to enrollees with both Medicare and Medicaid eligibility. It provides coverage for all Medicare-covered Part A and Part B services received from network providers as well as prescription drugs.
A Wellcare D-SNP is a special type of Medicare Advantage plan. D-SNPs are special because they provide additional support and benefits at no extra cost for people who qualify for both Medicaid and Medicare coverage.
Medicare beneficiaries may also enroll in Wellcare through the CMS Medicare Online Enrollment Center located at Medicare.gov. 4. Contact a licensed Medicare Sales Broker. They will be able to walk you through different plans and help you select the one that is best for you.
Introduction: My name is Kelle Weber, I am a magnificent, enchanting, fair, joyous, light, determined, joyous person who loves writing and wants to share my knowledge and understanding with you.
We notice you're using an ad blocker
Without advertising income, we can't keep making this site awesome for you.
