all-in-one guide 2022

All-In-One Guide 2022Choosing the Right Medicare Advantage Plan for Your Well-being.

Getting the right coverage is important, but that doesn’t mean it has to be confusing — or expensive.A little information can make a big difference when it comes to learning how Medicare works. It’s important for you to understand all your options to get the best value and coverage for your needs.

This All-In-One Guide will help you understand the basics of Medicare, and give you the information you need to choose the plan that’s right for you.

If you have any questions, we’re here to help.

CALL 1-866-360-8144 (TTY 711)8 a.m. to 8 p.m., 7 days a week

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Your health is our priority.Our priority is to ensure you have access to the care and resources you need to be your healthiest self. Everything from routine care and screenings plus these valuable benefits can be part of your Medicare coverage:

Prescription drug coverage with $0 Tier 1 generic drugs

Dental benefits

Vision benefits

Hearing benefits

Transportation benefits

Home-delivered meals

An over-the-counter allowance

Telehealth online doctor visits

24-hour nurse line

A free fitness membership

And more.

Read on to learn more about Medicare and the options available in your area.

Are you eligible for Medicare?

You can enroll in a Medicare plan if:

• You are about to, or have recently, turned 65

• You have a chronic health condition

• You are losing your retiree health coverage

• You are under the age of 65, but have received Social Security disability benefits for at least two years

• You are turning 65 and currently have Medicaid coverage

For more information call 1-800-MEDICARE (1-800-633-4227)24 hours a day, 7 days a week; TTY users may call 1-877-486-2048. Or visit www.medicare.gov.

The parts of Original Medicare

The optional parts of Medicare

Most people are automatically enrolled in Medicare Part A when they turn 65. Once you enroll in Part B, you can select your Medicare Advantage plan. Make sure you enroll in a plan with prescription drug coverage.

Part A Hospital Coverage

Part B Medical Coverage

Part C Medicare Advantage

Part D Prescription Drug Coverage

Important questions you should be asking.Choosing the right Medicare plan can be easier than you think—if you know what to look for. There’s a lot to consider as you explore your Medicare options, but if you start by asking these important questions, it will help you find a plan that fits.

Does the plan cover my prescription drugs? Original Medicare does NOT cover prescription drugs. But just because a Medicare Advantage plan offers prescription drug coverage, that doesn’t mean your specific drugs are covered. Be sure to check the prescription drug formulary of the plans you’re considering to see if your drugs are covered—and find out how much they’ll cost.

Does the plan have a strong network of local doctors and hospitals? Before you enroll in a plan, check to make sure its network includes the doctors you’d like to see, as well as your preferred local hospitals.

Am I missing out on any supplemental benefits? A Medicare Advantage plan covers everything Original Medicare does, PLUS EXTRA benefits like dental, vision, hearing, over-the-counter allowances, transportation and more.

When can you first enroll in Medicare?

The Medicare Initial Coverage Election Period is based on the month of your 65th birthday. You can enroll as early as three months before your birthday month or as late as three months after your birthday month.

When can you change your plan?All Medicare recipients have an opportunity to change their Medicare coverage during the Medicare Annual Enrollment Period, which begins on October 15 and ends on December 7 each year. The choices you make during the Annual Enrollment Period will take effect on January 1 of the upcoming year.

Special enrollment periods

There are special circumstances in which you may join a Part C or Part D plan at other times of the year, including:

• if you are on both Medicare and Medicaid

• if your current plan is terminated

• if you move to a new residence in a new service area

There are other special circumstances where you may qualify for a special enrollment period. If you have questions, call us at 1-866-360-8144 (TTY 711).

3 MONTHS BEFORE

3 MONTHS

AFTER

YOUR BIRTHDAY

MONTH

Find the plan that works for you.Different people have different needs. Wellcare has plans to fit your life.

PPO Plans With a Medicare Advantage Preferred Provider Organization (PPO) plan, you can pick your own doctor, and you don’t have to get referrals to see a specialist.

HMO Plans A Health Maintenance Organization (HMO) Medicare Advantage plan provides you with access to a network of contracted hospitals and providers. This type of plan often provides cost-savings, but requires you to stay in the contracted network.

C-SNP Plans Chronic Condition Special Needs Plans (C-SNPs) help manage conditions like diabetes, cardiovascular disease or congestive heart failure, among others, to reduce your health risks. These plans may target a single chronic condition or multiple conditions.

D-SNP Plans If you have Medicaid and Medicare, you may qualify for a Dual Special Needs (D-SNP) plan. These plans offer extra benefits for qualifying members at no cost. You may also get access to a care manager who can coach you on ways to reach your health goals.

Prescription drug coverageWellcare offers affordable Medicare Advantage plans that include Part D coverage with $0 or low copays.

Keep in mind that if you do not choose prescription drug coverage during your Initial Election Period, you may be subject to a penalty if you decide you want this important option later.

On the next few pages, you’ll see samples of plans your state may offer. This is not a complete description of benefits. Call a Licensed Representative for plan details in your service area. 1-866-360-8144 (TTY 711).

(HMO-POS)1 (HMO)3

Benefits & Services In-Network In-Network

Monthly Premium $0.00 $18.20

Maximum Out-of-Pocket $7,550 Combined $7,550

Doctor Visits Primary Care: $5 /visit Specialist: $40 /visit

Primary Care: $0 /visit Specialist: $30 /visit

Inpatient Hospital Stays $385 copay per day for days 1-5 and a $0 copay per day for days 6-90

$330 copay per day for days 1-4 and a $0 copay per day for days 5-90

Transportation N/A 24 one-way trips every year

Hearing Services $1,000 per year for up 2 hearing aids, max one per ear $2,000 per year for up 2 hearing aids, max one per ear

Vision Services $0 copay for a routine exam. Plus get up to $100 for unlimited contacts, glasses, lenses, and/or frames per year

$0 copay for a routine exam. Plus get up to $100 for unlimited contacts, glasses, lenses, and/or frames per year

Dental Services

$1,000 in preventive and comprehensive dental services, including exams, fillings and minor restorative services

($0 co-pay on preventive and 40% cost-share on comprehensive services)

$1,000 in preventive and comprehensive dental services, including exams, fillings, minor restorative services and

dentures ($0 co-pay)

Over-the-Counter Items5 $30 every quarter $100 every quarter

Fitness Benefits $0 $0

Prescription Drug Coverage/Deductible4 $350 Tiers 3 to 5 $480 Tiers 2 to 5

Preferred Generic Drug Copay (1-month supply)⁴ $0 at preferred pharmacies $0

Mail-Service Preferred Cost-Sharing $0 $0

Flex Card⁶ N/A N/A

In-Home Support Services⁷ N/A N/A

Example Wellcare Benefits in Your State

1If you have an out-of-network benefit, it’s possible for you to visit out-of-network providers. However, these visits may cost more than visits to in-network providers. ²You generally will pay a lower cost share for services received at a Tier 1 Provider. See the Summary of Benefits for details. ³If you do not have an out-of network benefit, you must use plan providers except in emergency or urgent care situations or for out-of-service area renal dialysis. If you obtain routine care from out-of-network providers, neither Medicare nor the plan will be responsible for costs. ⁴For plans that cover prescription drugs, it is important that you

(HMO)3 (HMO)2 (HMO)3

In-Network Tier 12 In-Network Tier 22 In-Network

$0.00 $0.00 $0.00

$5,900 $5,900 $7,550







N/A N/A 24 one-way trips every year

$3,000 per year for up 2 hearing aids, max one per ear $3,000 per year for up 2 hearing aids, max one per ear $3,000 per year for up 2 hearing aids, max one per ear

$0 copay for a routine exam. Plus get up to $200 for unlimited contacts, glasses, lenses,

and/or frames per year





$1,500 in preventive and comprehensive dental services, including exams, fillings, minor restorative

services and dentures ($0 co-pay )


services and dentures ($0 co-pay )


services and dentures ($0 co-pay)

$70 every quarter $70 every quarter $150 every quarter

$0 $0 $0

$75 Tiers 3 to 5 $75 Tiers 3 to 5 N/A

$0 at preferred pharmacies $0 at preferred pharmacies N/A

$0 $0 N/A

$200 per year $200 per year $500 per year

N/A N/A 6 visits every year.


review the formulary to understand what drugs are covered on this tier. If you qualify for Extra Help, you will pay the lower of the plan’s co-pay or your Extra Help/Low Income Subsidy (LIS) co-pay. ⁵Beneficiaries enrolling in a PPO or PFFS plan may be eligible to purchase items from a retailer for direct reimbursement. ⁶Flex Card benefit to be used to cover additional costs associated with dental, vision and hearing only. 7You must have certain chronic conditions to qualify for In-Home Support Services.

(PPO)1 (PPO)1

Benefits & Services In-Network Out-of-Network

Monthly Premium $0.00 $0.00

Maximum Out-of-Pocket $7,550 $11,300 Combined

Doctor Visits Primary Care: $0 /visit Specialist: $30 /visit


Inpatient Hospital Stays $375 copay per day for days 1-5 and a $0 copay per day for days 6-90


Transportation N/A N/A

Hearing Services $1,500 per year for up 2 hearing aids, max one per ear 40% coinsurance for hearing services and get up to $1,500 or up 2 hearing aids, max one per ear

Vision Services $0 copay for a routine exam Plus get up to $100 for unlimited contacts, glasses, lenses, and/or frames per year

40% coinsurance for a routine exam 40% coinsurance for eyewear/services and get up to $100 towards unlimited

contacts, glasses, lenses, and/or frames per year

Dental Services $1,000 in preventive and comprehensive dental services, including exams, fillings, minor restorative services and

dentures ($0 co-pay)

$1,000 in preventive and comprehensive dental services, including exams, fillings, minor restorative services and

dentures (50% cost share)

Over-the-Counter Items5 $40 every quarter $40 every quarter

Fitness Benefits $0 $0

Prescription Drug Coverage/Deductible4 $175 Tiers 3 to 5 $175 Tiers 3 to 5

Preferred Generic Drug Copay (1-month supply)⁴ $0 at preferred pharmacies $0 at preferred pharmacies

Mail-Service Preferred Cost-Sharing $0 $0

Flex Card⁶ $200 per year $200 per year

In-Home Support Services⁷ N/A N/A


1If you have an out-of-network benefit, it’s possible for you to visit out-of-network providers. However, these visits may cost more than visits to in-network providers. ²You generally will pay a lower cost share for services received at a Tier 1 Provider. See the Summary of Benefits for details. ³If you do not have an out-of network benefit, you must use plan providers except in emergency or urgent care situations or for out-of-service area renal dialysis. If you obtain routine care from out-of-network providers, neither Medicare nor the plan will be responsible for costs. ⁴For plans that cover prescription drugs, it is important that you review the formulary to understand what drugs are covered on this tier. If you qualify for Extra Help, you will pay the lower of the plan’s co-pay or your Extra Help/Low Income Subsidy (LIS) co-pay. ⁵Beneficiaries enrolling in a PPO or PFFS plan may be eligible to purchase items from a retailer for direct reimbursement. ⁶Flex Card benefit to be used to cover additional costs associated with dental, vision and hearing only.7You must have certain chronic conditions to qualify for In-Home Support Services.

We’re here to help.We hope this guide has helped you. If you have questions, or need assistance when it comes time to select a plan or enroll, don’t hesitate to give us a call.

1-866-360-8144 (TTY 711)8 a.m. to 8 p.m., 7 days a weekwellcarenow.com

(PPO)1 (PPO)1

In-Network Out-of-Network

$0.00, plus get $60.00 back in your Social Security check $0.00, plus get $60.00 back in your Social Security check

$7,550 $11,300 Combined


Primary Care: 40% /visit Specialist: 50% /visit

$330 copay per day for days 1-5 and a $0 copay per day for days 6-90 20% of the total cost for days 1-90

N/A N/A

$700 per year for up to 2 hearing aids, max one per ear 40% coinsurance for hearing services and get up to $700 for up 2 hearing aids, max one per ear

$0 copay for a routine exam. Plus get up to $100 for unlimited contacts, glasses, lenses, and/or frames per year

40% coinsurance for a routine exam 40% coinsurance for eyewear/services and get up to $100 towards unlimited

contacts, glasses, lenses, and/or frames per year

$750 in preventive and diagnostic dental services, including exams and fillings ($0 co-pay)

$750 in preventive and diagnostic dental services, including exams and fillings (50% cost-share)

N/A N/A

$0 $0

$300 Tiers 3 to 5 $300 Tiers 3 to 5

$0 at preferred pharmacies $0 at preferred pharmacies

$0 $0

N/A N/A

N/A N/A

Plans vary by region and not all benefits are covered on all plans. A more complete description of benefits is included in the Summary of Benefits document. Ask your licensed representative for details. ‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal. Our plans use a formulary. For accommodations of persons with special needs at meetings, call 1-877-699-3552 TTY 711. There is no obligation to enroll. Out-of-network/non-contracted providers are under no obligation to treat our members, except in emergency situations. Please call our Customer Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. WellCare’s pharmacy network includes limited lower-cost, preferred pharmacies in rural areas of MO and NE. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-833-444-9088 (TTY 711) for Wellcare No Premium (HMO) and Wellcare Giveback (HMO) in MO or consult the online pharmacy directory at www.wellcare.com/medicare, and 1-833-542-0693 (TTY 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO) and Wellcare No Premium Open (PPO) in NE or consult the online pharmacy directory at www. wellcare.com/NE. Contract services are funded in part under contract with the State of Arizona. Such services are funded in part with the state of New Mexico. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/Medicaid. TennCare is not responsible for payment for these benefits, except for appropriate cost sharing amounts. TennCare is not responsible for guaranteeing the availability or quality of these benefits.

© Wellcare 2021NAWCMBKT79998E_0022Y0020_WCM_79998E_Final22_M CMS Accepted

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all-in-one guide 2022

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