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Wellcare Dual Access (HMO D-SNP)

Wellcare Dual Access (HMO D-SNP) H3499-005 Plan Details
3 out of 5 stars

Wellcare Dual Access (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Centene Corporation
Plan ID: H3499-005

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$0.00
Monthly Premium

Wellcare Dual Access (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Centene Corporation
Plan ID: H3499-005

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Wellcare Dual Access (HMO D-SNP) H3499-005 Plan Details
3 out of 5 stars

Wellcare Dual Access (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Centene Corporation
Plan ID: H3499-005

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$0.00
Monthly Premium

Indiana Counties Served

Marion Tippecanoe Madison Tipton Perry Jay Brown Daviess Fulton Huntington Monroe Hendricks Decatur Vigo Porter Steuben Miami Lawrence Blackford Union Newton Grant Henry Posey Parke Clay Spencer Ohio Wabash Johnson Cass Jennings Sullivan Greene Orange Clinton Boone Montgomery Scott Crawford Shelby Jackson Ripley Pulaski Vermillion Lagrange Rush Harrison Jefferson Hamilton Switzerland Marshall Putnam Kosciusko Washington Wayne Starke Fountain Carroll Dubois Allen Martin Howard Wells Knox Gibson Delaware Lake Dearborn Vanderburgh Elkhart Dekalb Jasper La Porte Whitley Franklin Warren Owen Pike White Warrick Morgan Fayette Floyd Noble Benton Randolph Bartholomew St Joseph Clark Adams Hancock

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $8850
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0.00
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $0.00
Prior Authorization Required for Doctor Specialty Visit
Prior authorization required
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
Copayment for Acute Hospital Services per Stay $0.00
Prior Authorization Required for Acute Hospital Services
Prior authorization required
Urgent Care
Copayment for Urgent Care $0.00
Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $100.00
Maximum Plan Benefit of $50,000
Emergency Room Visit
Copayment for Emergency Care $0.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $100.00
Maximum Plan Benefit of $50,000
Ambulance Transportation
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $0.00

Air Ambulance:
Copayment for Air Ambulance Services $0.00

Please see Evidence of Coverage for Prior Authorization rules
Prior authorization required

Health Care Services and Medical Supplies

Wellcare Dual Access (HMO D-SNP) 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:
Copayment for Medicare-covered Chiropractic Services $0.00
Prior Authorization Required for Chiropractic Services
Prior authorization required
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Copayment for Medicare-covered Diabetic Supplies $0.00
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0.00
Prior Authorization Required for Diabetic Supplies and Services
Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage)
Prior authorization required
Durable Medical Eqipment (DME)
In-Network:
Copayment for Medicare-covered Durable Medical Equipment $0.00
Prior Authorization Required for Durable Medical Equipment
Prior authorization required
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0.00
Copayment for Medicare-covered Lab Services $0.00
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $0.00
Copayment for Medicare-covered Therapeutic Radiological Services $0.00
Copayment for Medicare-covered X-Ray Services $0.00
Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services
Prior authorization required
Home Health Care
In-Network:
Copayment for Medicare-covered Home Health Services $0.00
Prior Authorization Required for Home Health Services
Prior authorization required
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
Copayment for Psychiatric Hospital Services per Stay $0.00
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Mental Health Outpatient Care
In-Network:
Copayment for Medicare-covered Individual Sessions $0.00
Copayment for Medicare-covered Group Sessions $0.00
Prior Authorization Required for Outpatient Mental Health Services
Prior authorization required
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0.00
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services $0.00

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0.00
Prior Authorization Required for Ambulatory Surgical Center Services
Prior authorization required
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $0.00
Copayment for Medicare-covered Group Sessions $0.00
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Over-the-counter (OTC) Items
In-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $151.00 every month
Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $0.00
Prior Authorization Required for Podiatry Services
Prior authorization required
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0.00 per day for days 1 to 20
$0.00 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services
Prior authorization required

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:

Preventive Dental:
Copayment for Oral Exams $0.00
  • Maximum 2 visits every year
Copayment for Prophylaxis (Cleaning) $0.00
  • Maximum 2 visits every year
Copayment for Fluoride Treatment $0.00
  • Maximum 1 visit every year
Copayment for Dental X-Rays $0.00
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Referral Required for Preventive Dental

Comprehensive Dental:
Copayment for Medicare-covered Benefits $0.00
Copayment for Non-routine Services $0.00
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Diagnostic Services $0.00
  • Maximum 1 visit every year
Copayment for Restorative Services $0.00
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Endodontics $0.00
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Periodontics $0.00
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Extractions $0.00
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Maximum Plan Benefit of $3000.00 every year for Non-Medicare Covered Comprehensive
Prior Authorization Required for Comprehensive Dental
Prior authorization required

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0.00
Copayment for Routine Eye Exams $0.00
  • Maximum 1 Routine Eye Exam every year
Prior Authorization Required for Eye Exams

Eyewear:
Copayment for Medicare-Covered Benefits $0.00
Maximum Plan Allowance of $300.00 every year for all Non-Medicare covered eyewear
Prior Authorization Required for Eyewear
Prior authorization required

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $0.00
Copayment for Routine Hearing Exams $0.00
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0.00
  • Maximum 1 visit every year
Prior Authorization Required for Hearing Exams

Hearing Aids:
Copayment for Hearing Aids $0.00
  • Maximum 2 Hearing Aids every year
Maximum Plan Benefit of $1500.00 every year per ear
Prior Authorization Required for Hearing Aids
Prior authorization required

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:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
    • Tobacco use cessation
    Yearly "Wellness" visit

    Prescription Drug Costs and Coverage

    The Wellcare Dual Access (HMO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $0 per year.

    Coverage
    Cost
    Coverage & Cost
    Annual Drug Deductible $0
    Preferred Generic
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Generic
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Preferred Brand
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Non-Preferred Drug
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Specialty Tier
    • Standard retail $0.00
    • Standard retail $0.00
    • Standard retail $0.00
    • Standard mail order $0.00
    • Standard mail order $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    • Preferred cost-share retail $0.00
    • Preferred cost-share retail $0.00
    Annual Drug Deductible $0
    Preferred Generic
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Generic
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Preferred Brand
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Non-Preferred Drug
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Specialty Tier
    • Standard retail $0.00
    • Standard retail $0.00
    • Standard retail $0.00
    • Standard mail order $0.00
    • Standard mail order $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    • Preferred cost-share retail $0.00
    • Preferred cost-share retail $0.00
    Annual Drug Deductible $0
    Preferred Generic
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Generic
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Preferred Brand
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Non-Preferred Drug
    • Standard retail $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    Specialty Tier
    • Standard retail $0.00
    • Standard retail $0.00
    • Standard retail $0.00
    • Standard mail order $0.00
    • Standard mail order $0.00
    • Standard mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share mail order $0.00
    • Preferred cost-share retail $0.00
    • Preferred cost-share retail $0.00
    • Preferred cost-share retail $0.00
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