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2020 Medicare Advantage Plan Benefit Details for the WellCare Liberty (HMO D-SNP)

2020 Medicare Advantage Plan Details
Medicare Plan Name:WellCare Liberty (HMO D-SNP)
Location:Miami-Dade, Florida
Plan ID:H1032 - 176 - 0     Click to see other plans
Member Services:1-866-637-8041 TTY users 711
— Enrollment Options —
Medicare Contact Information:1-800-MEDICARE (1-800-633-4227)
TTY users 1-877-486-2048
Speak to a licensed sales agent to learn more and enroll.
Call Medicare Solutions at 855-373-9484 / TTY 711

Monday ‐ Friday 8:30am — 10pm EST
Email a copy of the WellCare Liberty (HMO D-SNP) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below)
Annual Deductible:$0 for people who qualify for both Medicare and Medicaid.
Annual Initial Coverage Limit (ICL):$4,020
Health Plan Type:Local HMO
Special Needs Plan (SNP)
Eligibility Requirement:
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:3,349 drugsBrowse the WellCare Liberty (HMO D-SNP) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:
Number of Drugs per
Plan's Pharmacy Search:http://www.wellcare.com/medicare
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 Miami-Dade, Florida:406 members
Number of Members enrolled in this plan in (H1032 - 176):407 members
Plan’s Summary Star Rating: 4 out of 5 Stars.
Customer Service Rating: 4 out of 5 Stars.
Member Experience Rating: 4 out of 5 Stars.
Drug Cost Accuracy Rating: 4 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows:
Part C
Part D Base
Part D Supplemental
Monthly Premium with Extra Help Low-Income Subsidy (LIS):100%
Monthly Part D Premium with LIS:$0.00$6.80$13.60$20.40
Total Monthly Premium with LIS (Parts C & D):$0.00$6.80$13.60$20.40
— Plan Health Benefits —
** Base Plan **
Premium Total monthly premium: $0.00
  Health plan premium: $0.00
  Drug plan premium: $0.00
  Standard Part B premium: $135.50
  Part B premium reduction: No
Deductible Health plan deductible: $0
  Drug plan deductible: $435.00
Estimated yearly costs Estimated total yearly costs for care: $0.00
Out-of-pocket max Out-of-pocket max: $3,400 In-network
Doctor services Primary doctor visit: $0 copay
  Specialist visit: $0 copay, Limits apply
Tests, labs, & imaging Diagnostic tests & procedures: $0 copay, Limits apply
  Lab services: $0 copay, Limits apply
  Diagnostic radiology services (like MRI): $0 copay, Limits apply
  Outpatient x-rays: $0 copay, Limits apply
  Emergency care: $0 copay
  Urgent care: $0 copay
Hospital services Inpatient hospital coverage: $0 copay, Limits apply
  Outpatient hospital coverage: $0 copay, Limits apply
Skilled nursing facility Skilled nursing facility: $0 copay, Limits apply
Preventive services Preventive services: $0 copay
Ambulance Ground ambulance: $0 copay
Therapy services Occupational therapy visit: $0 copay, Limits apply
  Physical therapy & speech & language therapy visit: $0 copay, Limits apply
Mental health services Outpatient group therapy with a psychiatrist: $0 copay, Limits apply
  Outpatient individual therapy with a psychiatrist: $0 copay, Limits apply
  Outpatient group therapy visit: $0 copay, Limits apply
  Outpatient individual therapy visit: $0 copay, Limits apply
Opioid treatment services Opioid treatment services: Covered
Other services Durable medical equipment (like wheelchairs & oxygen): $0 copay, Limits apply
  Prosthetics (like braces, artificial limbs): $0 copay, Limits apply
  Diabetes supplies: $0 copay, Limits apply
Hearing Hearing exam: $0 copay, Limits apply
  Fitting/evaluation: $0, Limits apply
  Hearing aids - All types: $0 copay, Limits apply
Preventive dental Oral exam: $0 copay, Limits apply
  Cleaning: $0 copay, Limits apply
  Fluoride treatment: $0 copay, Limits apply
  Dental x-rays: $0 copay, Limits apply
Comprehensive dental Non-routine services: Not covered
  Diagnostic services: $0, Limits apply
  Restorative services: $0, Limits apply
  Endodontics: $0, Limits apply
  Periodontics: $0, Limits apply
  Extractions: $0, Limits apply
  Prosthodontics, other oral/maxillofacial surgery, other services: $0, Limits apply
Vision Routine eye exam: $0, Limits apply
  Contact lenses: $0 copay, Limits apply
  Eyeglasses (frames & lenses): $0 copay, Limits apply
  Eyeglass frames (only): $0 copay, Limits apply
  Eyeglass lenses (only): $0 copay, Limits apply
  Upgrades: Not covered
More benefits Fitness benefit: Limited coverage
  Transportation services for non-emergency care: Any health-related locations: Not covered
  Transportation services for non-emergency care: Plan-approved locations: Limited coverage
  Over the counter drug benefits: Limited coverage
  In-home support services: Not covered
  Routine chiropractic service: Limited coverage
  Home and bathroom safety devices: Not covered
  Meals for short duration: Limited coverage
  Annual physical exams: Not covered
  Telehealth: Limited coverage
Part B drugs Chemotherapy drugs: $0 copay, Limits apply
  Other Part B drugs: $0 copay, Limits apply

Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing 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.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. 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 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.