Wellcare Giveback (HMO-POS)
Available to residents of Plaquemines County, LA for 2026. Contract H2491, plan 031, segment 0.
- ✉ Email a copy of the plan benefit details
- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Plaquemines County
- Plan website
- Browse the Wellcare Giveback (HMO-POS) formulary
New for 2026. This plan has no 2025 predecessor in the CMS crosswalk.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | $70.00 a month?You must continue to pay your Medicare Part B premium. |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $9,250.00? |
| Drug deductible | $615.00Tier 1, 2 and 6 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO-POS? |
| Contract / plan | H2491-031-0 |
| Offered by | Wellcare |
| Parent organization | Centene Corporation |
| Formulary drugs | 3,313 |
| Formulary exception tier | 4? |
| Pharmacy search | go.wellcare.com/Medicare |
| Member services | (555)555-5555TTY (555)555-5555 |
CMS star ratings
- Overall
- 3.5 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H2491 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $40 copay(authorization required) |
| Other health care professional | $0–$40 copay(authorization required) |
| Additional telehealth services | $0–$40 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | 20% coinsurance |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0–$50 copay(authorization required) |
| Lab services | $0–$50 copay(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | $0–$400 copay(authorization required) |
| Therapeutic radiology | 20% coinsurance(authorization required) |
| Outpatient x-rays | $50 copay(authorization required) |
| Emergency and urgent care | |
| Emergency room | $115 copay |
| Urgent care | $40 copay |
| Worldwide emergency coverage | $115 copay · $50,000 plan limit |
| Worldwide urgent care | $115 copay · $50,000 plan limit |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | $495 per day for days 1–4; $0 per day for days 5–90(authorization required) |
| Outpatient hospital services | $0–$500 copay(authorization required) |
| Outpatient observation | $115–$500 copay |
| Ambulatory surgical center | $350 copay(authorization required) |
| Outpatient blood services | $0 copay |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $218 per day for days 21–70; $0 per day for days 71–100(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | $35 copay(authorization required) |
| Physical therapy and speech-language therapy | $40 copay(authorization required) |
| Cardiac rehabilitation | $30 copay |
| Pulmonary rehabilitation | $25 copay |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $495 per day for days 1–4; $0 per day for days 5–90(authorization required) |
| Outpatient mental health, individual session | $40 copay(authorization required) |
| Outpatient mental health, group session | $40 copay(authorization required) |
| Psychiatrist, individual session | $40 copay(authorization required) |
| Psychiatrist, group session | $40 copay(authorization required) |
| Partial hospitalization | $105 copay(authorization required) |
| Intensive outpatient program | $105 copay(authorization required) |
| Outpatient substance use, individual session | $40 copay(authorization required) |
| Outpatient substance use, group session | $40 copay(authorization required) |
| Opioid treatment program | $40 copay(authorization required) |
| Ambulance and transportation | |
| Ground ambulance | $300 copay(authorization required) |
| Air ambulance | $300 copay(authorization required) |
| Transportation to plan-approved locations | Not covered |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $15 copay(authorization required) |
| Routine chiropractic care | Not covered |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | $40 copay(authorization required) |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $40 copay(authorization required) |
| Oral exams | $0 copay(authorization required, limits apply) |
| Cleanings | $0 copay(authorization required, limits apply) |
| Fluoride treatment | $0 copay(authorization required, limits apply) |
| Dental x-rays | $0 copay(authorization required, limits apply) |
| Other diagnostic dental services | $0 copay(authorization required, limits apply) |
| Other preventive dental services | $0 copay(authorization required, limits apply) |
| Restorative services (fillings, crowns) | Not covered |
| Endodontics (root canals) | Not covered |
| Periodontics (gum disease) | Not covered |
| Dentures and other removable prosthodontics | Not covered |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | Not covered |
| Oral and maxillofacial surgery | Not covered |
| Orthodontics | Not covered |
| Adjunctive general services | $0 copay(authorization required, limits apply) |
| Vision? | |
| Eye exam (Medicare-covered) | $0–$40 copay(authorization required) |
| Routine eye exam | $0 copay(authorization required, limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(authorization required, limits apply) |
| Eyewear plan limit | $100 plan limit every year |
| Contact lenses | $0 copay(authorization required, limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(authorization required, limits apply) |
| Eyeglass lenses | $0 copay(authorization required, limits apply) |
| Eyeglass frames | $0 copay(authorization required, limits apply) |
| Eyewear upgrades | $0 copay(authorization required, limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | $40 copay(authorization required) |
| Routine hearing exam | $0 copay(authorization required, limits apply) |
| Hearing aid fitting and evaluation | $0 copay(authorization required, limits apply) |
| Hearing aid plan limit | $350 plan limit every year |
| Hearing aids (all types) | $0 copay(authorization required, limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $35 copay(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Covered (allowance not stated) |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | $0 copay |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $0.00 |
| Tier 3 | 25% |
| Tier 4 | 49% |
| Tier 5 | 25% |
| Tier 6 | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $5.00 | n/a | $0.00 | $15.00 | $0.00 |
| Tier 2: Generic | $0.00 | $10.00 | n/a | $0.00 | $30.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $5.00 | n/a | $0.00 | $15.00 | $0.00 |
| Tier 2: Generic | $0.00 | $10.00 | n/a | $0.00 | $30.00 | $0.00 |
| Tier 3: Preferred Brand | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 49% | 50% | n/a | 49% | 50% | 49% |
| Tier 5: Specialty Tier | 25% | 25% | n/a | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 35 other LA counties
- Acadia
- Allen
- Ascension
- Assumption
- Avoyelles
- Cameron
- East Baton Rouge
- East Feliciana
- Evangeline
- Grant
- Iberia
- Iberville
- Jefferson
- Jefferson Davis
- Lafayette
- Lafourche
- LaSalle
- Livingston
- Orleans
- Pointe Coupee
- Rapides
- St. Bernard
- St. Charles
- St. Helena
- St. James
- St. John the Baptist
- St. Landry
- St. Martin
- St. Mary
- St. Tammany
- Vermilion
- Vernon
- Washington
- West Baton Rouge
- West Feliciana
Benefits in plain text
Wellcare Giveback (HMO-POS) (H2491-031-0) is a 2026 HMO-POS Medicare Advantage plan offered by Wellcare, available to residents of Plaquemines County, LA.
The monthly premium is $0.00 (Part C and Part D together).
The plan reduces the member's Medicare Part B premium by $70.00 a month (a "giveback"); the Part B premium itself must still be paid.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $9,250.00.
The drug deductible is $615.00. Tier 1, 2 and 6 exempt.
The plan's formulary lists 3,313 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $0.00; tier 3: 25%; tier 4: 49%; tier 5: 25%; tier 6: $0.00.
CMS gives the plan's contract (H2491) an overall rating of 3.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.