How much will you spend out of pocket for the services and prescription drugs you use regularly? Use the personalized search function in the Medicare Plan Finder on the website www.medicare.gov/plan-compare. If you do not join another plan before December 7, 2021, you will be enrolled in Wellcare No Premium Open (PPO).
Visit the Internal Revenue Service (IRS) website at www.irs.gov/Affordable-Care-Act/Individuals-and-Families for more information. Whenever this booklet says “we,” “us,” or “our,” it means Wellcare Of South Carolina, Inc. The table below compares 2021 and 2022 costs for Wellcare No Premium Open (PPO) in several key areas.
A copy of the Proof of Coverage is located on our website at www.wellcare.com/medicare. You can also call member services to ask us to mail you a Proof of Coverage. This is the most you will pay out of pocket for your covered Part A and Part B.
Inpatient hospital care begins the day you are formally admitted to the hospital with a doctor's order.
We Are Changing the Plan’s Name
Changes to Benefits and Costs for Next Year
Changes to the Monthly Premium
Changes to Your Maximum Out-of-Pocket Amounts
Your costs for covered medical services (such as copayments) with network providers count toward your in-network out-of-pocket maximum. Your prescription drug costs do not count toward your out-of-pocket maximum. After you pay $5,500 out-of-pocket for Part A and Part B covered services, you will pay nothing for covered Part A and Part B services from network providers for the rest of the calendar year.
Your costs for covered medical services (such as copays) from in-network and out-of-network providers count toward your total maximum out-of-pocket amount. Your outpatient prescription drug costs do not count toward your maximum purchase amount for medical services. After you pay $10,000 out-of-pocket for covered Part A and Part B services, you pay nothing for your covered Part A and Part B services from in-network or out-of-network providers for the rest of the calendar year .
Changes to the Provider Network
If you are receiving treatment, you have the right to request, and we will work with you to ensure that the medically necessary treatment you are receiving is not interrupted. If you feel that we have not provided you with a qualified provider to replace your previous provider, or that your care is not being properly managed, you have the right to appeal our decision. If you find that your doctor or specialist is leaving your plan, contact us so we can help you find a new provider for your care.
Changes to the Pharmacy Network
Changes to Benefits and Costs for Medical Services
Acupuncture received at PCP office. There is a $50 copay for Medicare-covered acupuncture received at a specialty office. For each covered hospital stay, you pay 20% of the total cost per day for days 1 to 90. For each covered hospital stay, you pay 40% of the total cost per day for days 1 to 90.
You pay 40% of the total price per day for each. Supplies - Out-of-Network Prosthetic Devices. You pay 40% of the total cost of each Medicare-covered service. limitations and exclusions apply). You pay 20% of the total in-network costs for non-routine services, diagnostic services, restorative services,.
Changes to Part D Prescription Drug Coverage
To learn more about changes we may make to the Drug List, see Chapter 5, Section 6 of the Evidence of Coverage.). Note: If you are in a program that helps you pay for your drugs ("Extra Help"), the information about costs for Part D prescription drugs may not apply to you. "Evidence of Coverage Rider for people who get extra help to pay for prescription drugs" (also called "Low Income Subsidy Rider" or "LIS Rider"), which tells you about the costs of your drugs.
How much you pay for a Part D drug depends on the drug payment phase you're in. You can look in Chapter 6, Section 2 of your Evidence of Coverage for more information about the stages.). The information below shows the changes for next year in the first two phases - the Annual Deductible Phase and the Initial Coverage Phase.
Most members do not reach the other two stages - the Coverage Gap Stage or the Catastrophic Coverage Stage. To get information about your costs at these stages, see Chapter 6, Sections 6 and 7, in the Evidence of Coverage, which is available on our website at www. wellcare.com/medicare. To learn how copayments and coinsurance work, see Chapter 6, Section 1.2, Types of out-of-pocket costs you may pay for covered drugs on your Evidence of Coverage.
During this phase, the plan will pay part of the cost of your medications and you will pay your share of the costs. For information on long-term delivery or mail order prescription charges, please refer to Chapter 6, Section 5 of your Proof of Coverage. Once your total drug costs reach $4,130, you move to the next phase (the coverage gap phase).
Once your total drug costs reach $4,430, you will move on to the next phase (Coverage Gap Phase). The other two stages of drug coverage – the Coverage Gap Stage and the Catastrophic Coverage Stage – are for people with high drug costs. For information about your costs at these stages, see Chapter 6, Sections 6 and 7, in your Evidence of Coverage.
Deciding Which Plan to Choose
If you want to stay in Wellcare No Premium Open (PPO)
If you want to change plans
Deadline for Changing Plans
People with Medicaid, those who get “extra help” paying for their medications, those who have or are leaving employer coverage, and those who are leaving the service area can make a change at other times of the year. .
Programs That Offer Free Counseling about Medicare
Programs That Help Pay for Prescription Drugs
The AIDS Drug Assistance Program (ADAP) helps ensure that ADAP-eligible individuals living with HIV/AIDS have access to life-saving HIV medication. Medicare Part D prescription drugs that are also covered by ADAP qualify for prescription cost-sharing assistance through the South Carolina AIDS Drug Assistance Program (ADAP).
Questions?
Getting Help from Wellcare No Premium Open (PPO)
Getting Help from Medicare
It has information on cost, coverage and quality ratings to help you compare Medicare health plans. You can find information about plans available in your area by using the Medicare Plan Finder on the Medicare website. Contains a summary of Medicare benefits, rights and protections and answers to the most frequently asked questions about Medicare.
