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.

Terry Turner, writer and researcher for RetireGuide
  • Written by
    Terry Turner

    Terry Turner

    Senior Financial Writer and Financial Wellness Facilitator

    Terry Turner has more than 30 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®).

    Read More
  • Edited By
    Lamia Chowdhury
    Lamia Chowdhury, editor for RetireGuide.com

    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.

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  • Published: September 9, 2022
  • Updated: September 16, 2022
  • 6 min read time
  • This page features 4 Cited Research Articles
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How to Cite RetireGuide.com's Article

APA Turner, T. (2022, September 16). Wellcare No Premium Open (PPO). RetireGuide.com. Retrieved September 30, 2022, from https://www.retireguide.com/medicare/medicare-advantage-plans/compare/h2775-106/

MLA Turner, Terry. "Wellcare No Premium Open (PPO)." RetireGuide.com, 16 Sep 2022, https://www.retireguide.com/medicare/medicare-advantage-plans/compare/h2775-106/.

Chicago Turner, Terry. "Wellcare No Premium Open (PPO)." RetireGuide.com. Last modified September 16, 2022. https://www.retireguide.com/medicare/medicare-advantage-plans/compare/h2775-106/.

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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.

2022 Overall Rating - 4 Stars

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.

Health Plan Rating - 3 and a Half Stars

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.

Wellcare No Premium Open (PPO) Health Plan Five-Star Ratings, 2022
  • 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.

Wellcare No Premium Open (PPO) Health Plan Zero-Star Ratings, 2022
  • 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.

Prescription Drug Plan Rating - 4 Stars

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.

Wellcare No Premium Open (PPO) Health Plan Five-Star Ratings, 2022
  • 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 $170.10 in 2022.

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.

Example of 2022 In-Network Copay for Wellcare No Premium Open (PPO) - h2775 106
SERVICEIN-NETWORK
Health Plan Deductible$0
Medical Premiums$0
Drug Plan Deductible$0
Prescription Premiums$0
Maximum Out-of-Pocket (in-network)$6,700
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Our Medicare experts will help you compare, build, and enroll in a plan that gets you the coverages you need at a price you can afford.

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.

Examples of Services and DME Coverage
BENEFITOUT-OF-POCKET COSTS IN-NETWORK OUT-OF-POCKET COSTS OUT-OF-NETWORK
Ambulance services (ground only)$350 copay$350 copay
Ambulatory surgical center$250 copay30% coinsurance
Chiropractic services (Medicare covered chiropractic services only)$20 copay (unlimited visits)30% coinsurance per visit (unlimited visits)
Diabetes supplies$0 copayment20% coinsurance
Diabetes self-management training$0 copayment$0 copayment
Diabetic therapeutic shoes or inserts20% coinsurance20% coinsurance
Diagnostic tests and procedures$0 copayment30% coinsurance
Diagnostic lab services$0 copayment30% coinsurance
Diagnostic X-rays$0 copayment30% coinsurance
Other diagnostic radiology services (MRIs, CTs)$0 – $300 copay30% coinsurance
Primary care doctor visits$0 copay$25 copay
Specialist visits$40 copay$60 copay
Durable medical equipment20% coinsurance20% coinsurance
Emergency care$90 copay$90 copay
Urgent care$35 copay$35 copay
Inpatient hospital careDays 1–6: $325 copay per day Days 7–90: $0 copay perDays 1–beyond: 30% of total cost
Transportation (non-ambulance)$0 copay75% 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.

Examples of Dental, Vision and Hearing Benefits in the Wellcare No Premium Open (PPO), 2022
BENEFITOUT-OF-POCKET COSTS IN-NETWORK OUT-OF-POCKET COSTS OUT-OF-NETWORK
Dental oral exam$0 copay50% coinsurance
Dental cleanings$0 copay50% coinsurance
Dental fluoride treatments$0 copay50% coinsurance
Dental — non-routine services$0 copay50% coinsurance
Dental diagnostic services$0 copay50% coinsurance
Dental — endodontics$0 copay50% coinsurance
Dental extractions$0 copay50% coinsurance
Prosthodontics, oral or maxillofacial surgery and other comprehensive dental services$0 copay50% coinsurance
Dental — periodontics$0 copay50% coinsurance
Dental X-rays$0 copay50% coinsurance
Vision — routine eye exam$0 copay40% coinsurance
Contact lenses$0 copay40% coinsurance
Eyeglasses (frames and lenses)$0 copay40% coinsurance
Eyeglass frames$0 copay40% coinsurance
Eyeglass lenses$0 copay40% coinsurance
Upgrades$0 copay40% coinsurance
Hearing exam$40 copay$60 copay
Hearing aid fitting and evaluation$0 copay40% coinsurance
Hearing aids$0 copay40% 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.

Copays and Coinsurance by Tier, Supply and Pharmacy, 2022
Tier1 Month Preferred Retail 3 Month Preferred Retail1 Month Standard Retail3 Month Standard Retail 1 Month Preferred Mail Order3 Month Preferred Mail Order1 Month Standard Mail Order3 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 Name42%42%44%44%42%42%44%44%
Tier 5 Select Care Drugs33%N/A33%N/A33%N/A33%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.

Everything will reset with the new year.

Last Modified: September 16, 2022

4 Cited Research Articles

  1. 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
  2. U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Costs at a Glance. Retrieved from https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
  3. U.S. Centers for Medicare & Medicaid Services. (n.d.). Your Medicare Costs. Retrieved from https://www.medicare.gov/your-medicare-costs
  4. U.S. Centers for Medicare & Medicaid Services. (n.d.). 2022 Medicare Costs. Retrieved from https://www.medicare.gov/Pubs/pdf/11579-medicare-costs.pdf