| Summary | Amount |
|---|
| Monthly plan premium | $0.00 |
| Medical deductible | $0 |
| Out-of-network maximum out-of-pocket | N/A |
| In-network maximum out-of-pocket | $6,700 |
| Combined maximum out-of-pocket | $10,000 |
| Drug deductible | $300 (excludes Tiers 1, 2, and 6) |
| Initial coverage limit | $5,030 |
| Catastrophic coverage limit | $8,000 |
Health plan disclaimers:
Wellcare
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. Washington residents: "Wellcare" is issued by Wellcare of Washington, Inc. Washington residents: "Wellcare" is issued by Wellcare Health Insurance Company of Washington, Inc. "Wellcare" is issued by Wellcare Prescription Insurance, Inc. For Allwell Arizona D-SNP plans: Contract services are funded in part under contract with the State of Arizona. For Allwell New Mexico D-SNP plans: Such services are funded in part with the state of New Mexico. For Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid. For Tennessee D-SNP plans: Notice: 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’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. General disclaimers We do not offer every plan available in your area. Currently we represent 6 organizations which offer 44 products in your area. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program to get information on all of your options. Agency represents Medicare HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click any of the Nondiscrimination links above in the Health plan disclaimers section. This information is not a complete description of benefits. Call 1-800-215-3128 (TTY: 711) for more information. Medicare beneficiaries may also enroll in the plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. Every year, Medicare evaluates plans based on a 5-star rating system. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call the Plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Total annual cost is calculated by adding up the total annual cost of any monthly premiums, applicable plan deductible(s) and estimates for all co-pay and co-insurance amounts that will be due for the medications and health benefits used throughout the year. Costs for medications and health benefits vary across pharmacies and health systems, so the costs provided are only estimates. Actual costs could vary. For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 8 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778 or consult www.socialsecurity.gov; or your Medicaid Office. You must have both Part A and B to enroll in a Medicare Advantage plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information. The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company. If the plan you are reviewing is a Medicare Advantage with drug coverage or a prescription drug plan then the next two disclaimers apply. Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Pharmacy Member Services for more information. Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible. To send a complaint to a Medicare Health Plan, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.
Wellcare
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. Washington residents: "Wellcare" is issued by Wellcare of Washington, Inc. Washington residents: "Wellcare" is issued by Wellcare Health Insurance Company of Washington, Inc. "Wellcare" is issued by Wellcare Prescription Insurance, Inc. For Allwell Arizona D-SNP plans: Contract services are funded in part under contract with the State of Arizona. For Allwell New Mexico D-SNP plans: Such services are funded in part with the state of New Mexico. For Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid. For Tennessee D-SNP plans: Notice: 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’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. General disclaimers We do not offer every plan available in your area. Currently we represent 6 organizations which offer 44 products in your area. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program to get information on all of your options. Agency represents Medicare HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click any of the Nondiscrimination links above in the Health plan disclaimers section. This information is not a complete description of benefits. Call 1-800-215-3128 (TTY: 711) for more information. Medicare beneficiaries may also enroll in the plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. Every year, Medicare evaluates plans based on a 5-star rating system. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call the Plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Total annual cost is calculated by adding up the total annual cost of any monthly premiums, applicable plan deductible(s) and estimates for all co-pay and co-insurance amounts that will be due for the medications and health benefits used throughout the year. Costs for medications and health benefits vary across pharmacies and health systems, so the costs provided are only estimates. Actual costs could vary. For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 8 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778 or consult www.socialsecurity.gov; or your Medicaid Office. You must have both Part A and B to enroll in a Medicare Advantage plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information. The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company. If the plan you are reviewing is a Medicare Advantage with drug coverage or a prescription drug plan then the next two disclaimers apply. Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Pharmacy Member Services for more information. Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible. To send a complaint to a Medicare Health Plan, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.
Qualified, Licensed Insurance Professionals
Curious about how a private Medicare Advantage plan can benefit you? Contact us today to speak with a licensed insurance agent who can guide you through your options. Alternatively, click “Compare Plans” to explore available Medicare Advantage plans in your area online. Your coverage is important—let us assist you in finding the plan that best fits your needs.