How much you will spend out of pocket for the services and prescription drugs you use regularly. Use the personalized search feature on the Medicare Plan Finder on the www.medicare.gov/plan-compare website. If you do not enroll in another plan by December 7, 2021, you will be enrolled in the Wellcare Giveback Open (PPO).
Please visit the Internal Revenue Service (IRS) website at www.irs.gov/Affordable-Care-Act/Individuals-and-Families for more information. When this booklet says "we," "us," or "us," it means Wellcare Health Insurance Of North Carolina, Inc. The table below compares the 2021 costs and 2022 costs for Wellcare Giveback Open (PPO) in several important 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 officially 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 co-pays and . deductibles) from network providers count toward your in-network maximum out-of-pocket amount. Your prescription drug costs do not count toward your maximum out-of-pocket amount. After you pay $7,550 out-of-pocket for covered Part A and Part B services, you pay nothing for your 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 copayments and deductibles) from in-network and out-of-network providers count toward your total maximum 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
We will help you choose a new qualified provider to continue managing your health care needs. If you are undergoing medical 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 believe that we have not provided you with a qualified provider to replace your previous provider or that your care is not being managed properly, you have the right to appeal our decision.
If you find out that your doctor or specialist is leaving your plan, please contact us so we can help you find a new provider to manage your care.
Changes to the Pharmacy Network
Changes to Benefits and Costs for Medical Services
Acupuncture received in a PCP office. You pay a $45 copay for Medicare-covered Acupuncture received in a Specialist's office. You pay a $5 copay for each professional service from a primary care provider, including nursing services training and education, remote monitoring and monitoring services. Other oral/maxillofacial surgery is not covered. Other Comprehensive services are not covered. limitations and exclusions apply).
Changes to Part D Prescription Drug Coverage
To find out what you need to do to claim an exemption, see Proof of Coverage. Proof of coverage is available on our website at www.wellcare.com/medicare or by calling member services and asking for a copy to be mailed to you. See Chapter 9 Evidence of Coverage (What to do if you have a problem or complaint (coverage decisions, appeals, appeals)).
To learn more about changes we can make to the drug list, see Chapter 5, Section 6 of the Evidence of Coverage.). Evidence of coverage rider for people who get extra help paying for prescription drugs” (also called the “Low Income Subsidy rider” or the “LIS rider”), which tells you about your drug costs. How much you pay for a Part D drug depends on what drug payment stage you are in.
You can refer to Chapter 6, Section 2 of your Proof of Coverage for more information about the phases. 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 phases: the coverage gap phase or the catastrophic coverage phase.
For information about your costs at these stages, see Chapter 6, Sections 6 and 7, of the Certificate of Cover, which is located 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 can pay for covered drugs in your Certificate of Coverage. During this phase, the plan pays its share of the cost of your drugs and you pay your share of the costs.
For information about the cost for a long-term supply or for mail-order prescriptions, look in Chapter 6, Section 5 of your Proof of Coverage. The other two drug coverage stages – 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 Proof of Cover.
Deciding Which Plan to Choose
If you want to stay in Wellcare Giveback 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 move out of 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
North Carolina has a program called the HIV Treatment Assistance Program (HMAP) that helps people pay for prescription drugs based on their financial need, age or medical condition. To learn more about the program, contact your state's health insurance assistance program (see section 5 of this booklet for the name and phone numbers of this organization).
Questions?
Getting Help from Wellcare Giveback Open (PPO)
Getting Help from Medicare
For more information about the program, please contact the State Health Insurance Assistance Program (the name and telephone numbers of this organization are in Chapter 5 of this booklet). quality ratings to help you compare Medicare health plans. You can find information about the plans available in your area by using the Medicare Plan Finder on the Medicare website.
