2022 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Wellcare Giveback (HMO) | ||||
Location: | Orange, Texas Click to see other locations | ||||
Plan ID: | H0174 - 013 - 0 Click to see other plans | ||||
Member Services: | |||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
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Email a copy of the Wellcare Giveback (HMO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 | ||||
Medicare Part B Premium Reduction: | This plan has a $95 Part B monthly premium rebate (or giveback). However, you must continue to pay your Medicare Part B premium. | ||||
Annual Deductible: | $300 | ||||
Annual Initial Coverage Limit (ICL): | $4,430 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $6,700 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,415 drugs | Browse the Wellcare Giveback (HMO) Formulary | |||
This plan has 6 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $0.00 | $2.00 | $20.00 | $90.00 | 28% |
• Number of Drugs per Tier: | 221 | 420 | 936 | 909 | 695 |
Plan Offers Mail Order? | Yes | ||||
Medicare Plan Pharmacy Numbers: | BIN: 004336 PCN: MEDDADV See BIN/PCNs for all plans | ||||
Number of Members enrolled in this plan in Orange, Texas: | 211 members | ||||
Number of Members enrolled in this plan in (H0174 - 013): | 26,794 members | ||||
Plan’s Summary Star Rating: | 3.5 out of 5 Stars. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | Insufficient data to rate this plan. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. |
— Plan Health Benefits — |