Plan H9630-005-0: Wellcare Assist (HMO-POS) – 2025 Coverage Details for Sebastian County, AR
This page provides coverage, cost, and availability details for Wellcare by Allwell’s H9630-005-0 Medicare Advantage plan for 2025.
See more Medicare Advantage Plans in Sebastian County, Arkansas.
*CMS rated this Wellcare by Allwell plan (H9630-005-0) 3.5 (Above Average) out of 5 stars.
Wellcare Assist Basic Plan Details
- Plan ID
- H9630-005-0
- Plan Type
- HMO-POS
- Plan Year
- 2025
- Premium
- $18.40/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 4,800.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Basic, $580.00 deductible
- Supplemental Benefits
- Vision, Hearing
- Availability
- Sebastian County, AR
- Insured By
- Wellcare by Allwell
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
This Wellcare by Allwell Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H9630-005-0.
NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
Doctor's Office Visits
- Primary
- $0 Copay
- Specialist
- $25 Copay
Prior Authorization Required
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $125 Copay
- Urgent care
- $40 Copay
- Ground ambulance
- $275 Copay
- Inpatient hospital care
- $350.00 per day for days 1 through 6
$0.00 per day for days 7 and beyond - Skilled Nursing Facility
- $0.00 per day for days 1 through 20
$214.00 per day for days 21 through 40
$0.00 per day for days 41 and beyond
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $25 Copay
Prior Authorization Required - Routine Foot Care
- Not Covered
Chiropractic Care
- Medicare-covered chiropractic
- $20 Copay
Prior Authorization Required - Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- $40 Copay
- Outpatient group therapy
- $40 Copay
- Inpatient psychiatric hospital care
- $350.00 per day for days 1 through 6
$0.00 per day for days 7 and beyond
Rehabilitation Services
- Physical therapy and speech and language therapy
- $25 Copay
Prior Authorization Required - Occupational therapy
- $25 Copay
Prior Authorization Required
Medical Equipment and Supplies
- Diabetes supplies
- $0 Copay
Prior Authorization Required - Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $280 Copay
Prior Authorization Required - Lab services
- $50 Copay
Prior Authorization Required - Outpatient x-rays
- $25 Copay
Prior Authorization Required - Diagnostic tests and procedures
- $0 Copay
Prior Authorization Required
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- $25 Copay
Prior Authorization Required - Oral exam
- $0 Copay
Prior Authorization Required - Dental x-rays
- $0 Copay
Prior Authorization Required - Cleaning
- $0 Copay
Prior Authorization Required - Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Covered
Limits may apply - Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- $ to $25 Copay
- Routine eye exam
- $0 Copay
1 Every year - Eyewear benefits
- Eyeglasses: No
Contact Lenses: No
Eyeglass Lenses: No
Eyeglass Frames: No
Eyewear Upgrades: No - Maximum eyewear benefit:
- $2.00
Every three years
Get a copy of the Wellcare Assist Summary of Benefits.
Prescription Drug Costs & Benefits
Wellcare Assist includes a basic benefit Medicare Part D plan (PDP). Basic plans meet the minimum coverage standards set by the Centers for Medicare & Medicaid Services (CMS). These plans may have higher cost-sharing, deductibles, or limited drug coverage compared to enhanced plans, but they still provide essential prescription drug coverage at a lower premium.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $18.40 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $580.00. You must pay this amount at the pharmacy before Wellcare by Allwell begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Wellcare Assist has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $10.00 | $19.00 |
| Generic | $19.00 | $20.00 |
| Preferred Brand | 22.00% | 22.00% |
| Non-Preferred Drug | $100.00 | $100.00 |
| Specialty Tier | 25.00% | 25.00% |
| Select Care Drugs* | $0.00 | $0.00 |
| *The Part D deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories using a 5-star rating system. Here are the most recent CMS ratings for Wellcare Assist .
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Additional Plan Options
The Medicare Part C program offers a myriad of HMO, PPO, and PFFS plan options, including these plans:
- Wellcare Assist (HMO-POS)
- Wellcare Simple (HMO-POS)
- Wellcare Giveback (HMO-POS)
- Wellcare Patriot Giveback Preferred (HMO-POS)
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Contact Us About Wellcare by Allwell
| Website: | Wellcare by Allwell Plan Page (opens in new tab) |
|---|---|
| Providers: | Wellcare by Allwell Providers Page (opens in new tab) |
| Formulary: | Wellcare by Allwell Formulary Page (opens in new tab) |
| Pharmacy: | Wellcare by Allwell Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (800)225-8017 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)270-5320 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part C program on www.medicare.gov or call 1-800-MEDICARE.
Citations & References
- Wellcare by Allwell, http://www.wellcare.com/allwellAR, Last Accessed March 1, 2025
- Medicare.gov, "Medicare Advantage Plans cover all Medicare services", Last Accessed February 20, 2024
- Medicare.gov, "How Original Medicare Works", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You", Last Accessed February 19, 2024
- Medicare.gov, "What Medicare Covers", Last Accessed March 19, 2025
- CMS.gov, Landscape Source Files, Last Accessed March 15, 2025
- CMS.gov, Medicare Part C & D Performance, Last Accessed March 15, 2025
- CMS.gov, Plan Benefits Package,Last Accessed March 15, 2025
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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