Wellcare Giveback Open (PPO)
The Giveback Open PPO is a Medicare Advantage plan offered by Wellcare. It provides coverage for Medicare Part A, Part B and Part D. The Giveback Open PPO is not available in all areas, and costs may vary depending on where you live.
- 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
- 5 min read time
- This page features 5 Cited Research Articles
- Edited By
Wellcare Give Back Open (PPO) CMS Star Ratings
Each year Medicare releases “Star Ratings” for Medicare Advantage plans and Medicare Part D prescription drug plans.
Plans are rated on a one-to-five scale — with one star representing poor performance and five stars representing excellent performance.
Wellcare Giveback PPO Health Plan Rating
The Wellcare Giveback Open PPO received an overall rating of 3 1/2 stars for its health plan in 2022.
The rating was an average of 33 factors the plans beneficiaries rated through Medicare. Factors ranged from the quality of service, costs, coverage and other factors.
The plan received five-star ratings for getting appointments and care quickly, improvement in the plan’s performance and availability of TTY and foreign language interpretation when beneficiaries called the plan.
It got zero stars for assessment of beneficiaries’ health needs and risks, annual reviews of beneficiaries’ medications and supplements, and yearly pain screening or pain management plans.
Wellcare Giveback PPO Prescription Drug Plan Rating
The Wellcare Giveback Open PPO Medicare Part D prescription drug plan received an overall rating of four stars in 2022.
The rating is an average of 16 factors beneficiaries rated through Medicare. Factors ranged from beneficiaries’ experience with the plan to prescription prices.
The drug plan scored five stars in seven of the 16 categories, including customer service, accuracy in pricing and access to a pharmacist to help them understand and manage their prescriptions.
Its lowest score was two stars for beneficiaries’ rating of the drug plan.
Costs and Coverage
Costs and coverage for the Wellcare Giveback PPO plan vary by location. You should check the costs in your zip code for out-of-pocket costs. As with all Medicare Advantage plans, you have to pay the Medicare Part B premium: $164.90 in 2023.
The term “Giveback” in the plan’s name refers to the amount of discount toward your Medicare Part B premium the plan pays you. It was around $75 for the plans reviewed.
Since it is a PPO, you will have to pay more if you use a doctor, hospital or other health care provider not in the plan’s network.
| SERVICE | IN-NETWORK |
|---|---|
| Deductible | Varies by ZIP Code ($0 to $300)* |
| Medical Premiums | $0 |
| Drug Plan Premium | Included in monthly premium |
| Prescription Premiums | Varies by ZIP Code ($200 to $325 for Tiers 3, 4 & 5)* |
| Maximum Out-of-Pocket (in-network) | $7,550 |
Health Care Services and DME Coverage
The Wellcare Giveback Open PPO coverage for health care services and durable medical equipment covers everything that Original Medicare covers. It also includes additional services not covered by Original Medicare.
Costs and copays vary depending on your ZIP Code.
| BENEFIT | IN-NETWORK OUT-OF-POCKET COSTS | OUT-OF-NETWORK OUT-OF-POCKET COSTS |
|---|---|---|
| Ambulance services | $290 | $290 |
| Ambulatory surgical center | $250 | 40% |
| Chiropractic services (Medicare-covered chiropractic services only) | $20 | 40% |
| Diabetes supplies | $0 | 20% |
| Diagnostic tests, lab & radiology, and X-Rays | $0 | 40% |
| Specialist visits | $50 | 40% |
| Durable medical equipment | 20% | 20% |
| Emergency care | $90 | $90 |
| Inpatient hospital care | $370 copay per day for days 1-5 and $0 copay for days 6-90 | 20% of cost for days 1-90 |
| Renal dialysis | 20% | 20% |
| Transportation | Not covered | Not covered |
You should consider out-of-pocket costs for these types of services when you compare Medicare Advantage plans.
Dental, Vision and Hearing Benefits
The Wellcare Giveback Open PPO offers dental, vision and hearing services not offered through Original Medicare. Using out-of-network providers may result in substantially higher out-of-pocket costs. You should check with your plan before scheduling services.
| BENEFIT | IN-NETWORK OUT-OF-POCKET COSTS | OUT-OF-NETWORK OUT-OF-POCKET COSTS |
|---|---|---|
| Dental services (comprehensive and preventative) | Up to $500 | Up to $500 with a coinsurance payment of 50% |
| Vision | Routine eye exams and up to $100 for unlimited contacts, glasses, lenses and/or frames each year | Routine eye exams and up to $100 with a 40% coinsurance for all services toward unlimited contacts, glasses, lenses and/or frames each year |
| Hearing Services | Free annual exams, fittings, evaluation and up to $700 per year for a hearing aid (maximum of one hearing aid per ear each year). | Annual exams, fittings and evaluation with a 40% coinsurance — and up to $700 per year for a hearing aid (maximum of one hearing aid per ear each year). |
Prescription Drug Costs and Coverage
The Wellcare Giveback Open PPO plan includes a Part D prescription drug plan as part of your monthly premium. The annual deductible is $325 for 2022 and applies to drugs in Tiers 3, 4 and 5 of the plan.
| 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 | $1 | $3 | $6 | $18 | $1 | $0 | $6 | $18 |
| 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 | 48% | 48% | 50% | 50% | 48% | 48% | 50% | 50% |
| Tier 5 Specialty Drugs | 27% | N/A | 27% | N/A | 27% | N/A | 27% | N/A |
| Tier 6 Select Care Drugs | $0 | $0 | N/A | N/A | $0 | $0 | $0 | $0 |
Your share of the cost may vary based on your choice of pharmacy when you enter another phase of the Medicare Part D benefit. Beneficiaries receiving Extra Help assistance are not required to fill their prescriptions at in-network pharmacies in order to receive Low Income Subsidy copays.
Catastrophic coverage kicks in after your total out-of-pocket costs reach $7,050. At this point you pay either 5% of the drug’s cost or $3.95 for a generic or drug treated as a generic — or 5% or $9.85 for all other drugs. You will pay the greater amount in either case.
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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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