Wellcare No Premium Open (PPO)
The Wellcare No Premium Open (PPO) Medicare Advantage plan uses a network of local health care providers and is not available in all ZIP Codes. It includes a Medicare Part D prescription drug plan as well as a wide number of vision, dental and hearing benefits that Original Medicare does not include.
- Written by Terry Turner
Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).
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Lamia Chowdhury
Lamia Chowdhury
Financial Editor
Lamia Chowdhury is a financial content editor for RetireGuide and has over three years of marketing experience in the finance industry. She has written copy for both digital and print pieces ranging from blogs, radio scripts and search ads to billboards, brochures, mailers and more.
Read More- Published: September 9, 2022
- Updated: January 17, 2023
- 6 min read time
- This page features 5 Cited Research Articles
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Wellcare No Premium Open (PPO) CMS Star Ratings
The Wellcare No Premium Open PPO (H2775-106) Medicare Advantage plan has an overall rating of four out of five stars on Medicare’s Five-Star rating system. One star represents poor while five stars represents excellent.
The overall rating is based on individual ratings of the health and drug plans included in the Wellcare No Premium Open (PPO).
Medicare bases ratings on member satisfaction surveys and health care providers along with other feedback on plans. They are designed to reflect experiences of beneficiaries enrolled in Medicare Advantage and Medicare Part D prescription drug plans.
Wellcare No Premium Open (PPO) Health Plan Rating
The Wellcare No Premium Open (PPO) health plan was rated at 3 1/2 stars on Medicare’s scale.
The health plan overall rating is based on 33 separate criteria. The Wellcare No Premium Open (PPO) health plan scored five stars in three of the criteria.
- Getting appointments and care quickly
- Improvements — if any — to the plan’s performance
- TTY and foreign language interpreters when calling the health plan
Its lowest ratings — zero stars — came in three areas.
- Annual pain screening and pain management plan
- Annual review of all medications and supplements that members were taking
- Members whose plan assessed their health risks and needs
The plan’s rating was buoyed by scoring four-stars in 17 of the remaining 27 categories.
Wellcare No Premium Open (PPO) Drug Plan Rating
The Wellcare No Premium Open (PPO) health plan scored an overall four out of five stars from Medicare.
Medicare rates drug plans based on 16 criteria. The Wellcare No Premium Open (PPO) plan scored five-star ratings in seven of the 16 categories.
- Customer service
- Drug safety and drug pricing accuracy
- Members taking blood pressure medications as directed
- Members taking cholesterol medication as directed
- Members taking diabetes medication as directed
- Members who had a pharmacist or other health care professional help them understand and manage their medications
- TTY and foreign language interpreters when calling the plan
The Wellcare No Premium Open (PPO) drug plan’s lowest rating — two-stars — went to just one category: members’ rating of the drug plan.
Costs and Coverage
The Wellcare No Premium Open (PPO) does not have an additional monthly premium, but — as with all Medicare Advantage plans — you still have to pay the Medicare Part B premium which is $164.90 in 2023.
The plan covers everything that Original Medicare — Medicare Part A hospital insurance and Part B medical insurance — does but includes some benefits that Original Medicare does not cover.
| SERVICE | IN-NETWORK |
|---|---|
| Health Plan Deductible | $0 |
| Medical Premiums | $0 |
| Drug Plan Deductible | $0 |
| Prescription Premiums | $0 |
| Maximum Out-of-Pocket (in-network) | $6,700 |
Health Care Services and Durable Medical Equipment (DME) Coverage
The Wellcare No Premium Open plan is a PPO — preferred provider organization. This means it relies on a network of doctors, hospitals, medical equipment suppliers and other health care providers in your local area.
Wellcare contracts with these providers to offer services and supplies at a fixed rate. Going outside this network will cost you more than using the providers in the network.
| BENEFIT | OUT-OF-POCKET COSTS IN-NETWORK | OUT-OF-POCKET COSTS OUT-OF-NETWORK |
|---|---|---|
| Ambulance services (ground only) | $350 copay | $350 copay |
| Ambulatory surgical center | $250 copay | 30% coinsurance |
| Chiropractic services (Medicare covered chiropractic services only) | $20 copay (unlimited visits) | 30% coinsurance per visit (unlimited visits) |
| Diabetes supplies | $0 copayment | 20% coinsurance |
| Diabetes self-management training | $0 copayment | $0 copayment |
| Diabetic therapeutic shoes or inserts | 20% coinsurance | 20% coinsurance |
| Diagnostic tests and procedures | $0 copayment | 30% coinsurance |
| Diagnostic lab services | $0 copayment | 30% coinsurance |
| Diagnostic X-rays | $0 copayment | 30% coinsurance |
| Other diagnostic radiology services (MRIs, CTs) | $0 – $300 copay | 30% coinsurance |
| Primary care doctor visits | $0 copay | $25 copay |
| Specialist visits | $40 copay | $60 copay |
| Durable medical equipment | 20% coinsurance | 20% coinsurance |
| Emergency care | $90 copay | $90 copay |
| Urgent care | $35 copay | $35 copay |
| Inpatient hospital care | Days 1–6: $325 copay per day Days 7–90: $0 copay per | Days 1–beyond: 30% of total cost |
| Transportation (non-ambulance) | $0 copay | 75% coinsurance |
Dental, Vision and Hearing Benefits
The Wellcare No Premium Open (PPO) provides fuller coverage in the areas that Original Medicare does not: dental, vision and hearing services.
| BENEFIT | OUT-OF-POCKET COSTS IN-NETWORK | OUT-OF-POCKET COSTS OUT-OF-NETWORK |
|---|---|---|
| Dental oral exam | $0 copay | 50% coinsurance |
| Dental cleanings | $0 copay | 50% coinsurance |
| Dental fluoride treatments | $0 copay | 50% coinsurance |
| Dental — non-routine services | $0 copay | 50% coinsurance |
| Dental diagnostic services | $0 copay | 50% coinsurance |
| Dental — endodontics | $0 copay | 50% coinsurance |
| Dental extractions | $0 copay | 50% coinsurance |
| Prosthodontics, oral or maxillofacial surgery and other comprehensive dental services | $0 copay | 50% coinsurance |
| Dental — periodontics | $0 copay | 50% coinsurance |
| Dental X-rays | $0 copay | 50% coinsurance |
| Vision — routine eye exam | $0 copay | 40% coinsurance |
| Contact lenses | $0 copay | 40% coinsurance |
| Eyeglasses (frames and lenses) | $0 copay | 40% coinsurance |
| Eyeglass frames | $0 copay | 40% coinsurance |
| Eyeglass lenses | $0 copay | 40% coinsurance |
| Upgrades | $0 copay | 40% coinsurance |
| Hearing exam | $40 copay | $60 copay |
| Hearing aid fitting and evaluation | $0 copay | 40% coinsurance |
| Hearing aids | $0 copay | 40% coinsurance |
Prescription Drug Costs and Coverage
The Wellcare No Premium Open PPO Medicare Advantage includes Medicare Part D prescription drug coverage.
You should check the plan’s formulary — the list of drugs the plan covers — to make sure your medications are covered. You will also save money by using pharmacies in the plan’s network. Ordering 90-day supplies from a preferred mail-order pharmacy may save you more money on your medications.
| Tier | 1 Month Preferred Retail | 3 Month Preferred Retail | 1 Month Standard Retail | 3 Month Standard Retail | 1 Month Preferred Mail Order | 3 Month Preferred Mail Order | 1 Month Standard Mail Order | 3 Month Standard Mail Order |
|---|---|---|---|---|---|---|---|---|
| Tier 1 Preferred Generic | $0 | $0 | $5 | $15 | $0 | $0 | $5 | $15 |
| Tier 2 Generic | $7 | $21 | $12 | $36 | $7 | $0 | $12 | $36 |
| Tier 3 Preferred Brand Name | $37 | $111 | $47 | $141 | $37 | $74 | $47 | $141 |
| Tier 4 Non- Preferred Brand Name | 42% | 42% | 44% | 44% | 42% | 42% | 44% | 44% |
| Tier 5 Select Care Drugs | 33% | N/A | 33% | N/A | 33% | N/A | 33% | N/A |
| Tier 6 Select Care Drugs | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
Gap and Catastrophic Coverage
After you and the plan have paid a total of $4,430 on drugs in a single year, you hit gap coverage. From this point until you hit the maximum out-of-pocket threshold of $6,350, you will pay 25% of the cost of all generic or brand name drugs except for Tier 6 Select Care Drugs.
Both retail and mail-order drugs Tier 6 prescription drugs will have a $0 copay while you are in the gap coverage phase.
When your total out-of-pocket spending hits $6,350, you will hit a catastrophic coverage phase. At this point, you will pay $3.95 for all generic drugs — or 5% of the cost, whichever is higher. You also pay $9.85 — or 5% of the cost — for all brand name drugs, whichever is higher.
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5 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022, September 27). 2023 Medicare Parts A and B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
- U.S. Centers for Medicare & Medicaid Services. (2022, April 29). CY 2023 Medicare Advantage and Part D Final Rule (CMS-4192-F). Retrieved from https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-advantage-and-part-d-final-rule-cms-4192-f
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Costs at a Glance. Retrieved from https://www.medicare.gov/basics/costs/medicare-costs
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Your Medicare Costs. Retrieved from https://www.medicare.gov/basics/costs
- U.S. Centers for Medicare & Medicaid Services. (n.d.). 2022 Medicare Costs. Retrieved from https://www.medicare.gov/Pubs/pdf/11579-medicare-costs.pdf
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