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Wellcare No Premium (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Wellcare Health Plans, Inc.
Plan ID: H6975-005
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$0.00
Monthly Premium
Wellcare No Premium (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Wellcare Health Plans, Inc.
Plan ID: H6975-005
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
Wellcare No Premium (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Wellcare Health Plans, Inc.
Plan ID: H6975-005
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
$0.00
Monthly Premium
Alabama Counties Served
Colbert Lawrence Lauderdale Noxubee Winston Dade Madison Baldwin Mobile Saint Clair Blount Cherokee Etowah Walker Coosa Chilton Autauga Dallas Jefferson Bibb Shelby Talladega Clay Cullman Escambia Houston Dale Geneva Coffee Washington Covington Cleburne Perry Calhoun Sumter Choctaw
Basic Costs and Coverage
Coverage | Cost |
---|---|
Monthly Deductible | $0 |
Out of Pocket Max | In-Network: $4500 Out-of-Network: N/A |
Initial Coverage Limit | $5030 |
Catastrophic Coverage Limit | $8,000 |
Primary Care Doctor Visit | In-Network: Doctor Office Visit: |
Specialty Doctor Visit | In-Network: Doctor Specialty Visit: |
Inpatient Hospital Care | In-Network: Acute Hospital Services: |
Urgent Care | Copayment for Urgent Care $25.00 Worldwide Coverage: |
Emergency Room Visit | Copayment for Emergency Care $120.00 Worldwide Coverage: |
Ambulance Transportation | In-Network: Ground Ambulance: Air Ambulance: Please see Evidence of Coverage for Prior Authorization rules |
Health Care Services and Medical Supplies
Wellcare No Premium (HMO) 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: |
Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: |
Durable Medical Eqipment (DME) | In-Network: |
Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Outpatient Diag/Therapeutic Rad Services: |
Home Health Care | In-Network: |
Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: |
Mental Health Outpatient Care | In-Network: |
Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Outpatient Observation Services: Ambulatory Surgical Center Services: |
Outpatient Substance Abuse Care | In-Network: |
Over-the-counter (OTC) Items | In-Network: Over-The-Counter (OTC) Items: |
Podiatry Services | In-Network: |
Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: |
Dental Benefits
The following dental services are covered from in-network providers.
Coverage | Cost |
---|---|
Dental Care | In-Network: Preventive Dental:
Copayment for Prophylaxis (Cleaning) $0.00
Copayment for Fluoride Treatment $0.00
Copayment for Dental X-Rays $0.00
Referral Required for Preventive Dental Comprehensive Dental:
Copayment for Diagnostic Services $0.00
Copayment for Restorative Services $0.00
Copayment for Endodontics $0.00
Copayment for Periodontics $0.00
Copayment for Extractions $0.00
Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00
Maximum Plan Benefit of $2000.00 every year for Non-Medicare Covered Comprehensive |
Vision Benefits
The following vision services are covered from in-network providers.
Coverage | Cost |
---|---|
Vision Benefits | In-Network: Eye Exams:
Prior Authorization Required for Eye Exams Eyewear: |
Hearing Benefits
The following hearing services are covered from in-network providers.
Coverage | Cost |
---|---|
Hearing Benefits | In-Network: Hearing Exams:
Copayment for Fitting/Evaluation for Hearing Aid $0.00
Prior Authorization Required for Hearing Exams Hearing Aids:
Maximum Plan Benefit of $1000.00 every year per ear |
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: Abdominal aortic aneurysm screening
Tobacco use cessation |
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