Allwell Medicare Simple is a new plan for 2021. As such it has not been rated by CMS.
NOTE: Many new plans enter the market with low premiums and low co-pays. Remember, it's important to evaluate plans every year. This is particularly true with new plans.
Allwell Medicare Simple 2021 Medicare Advantage HMO Plan for Berks County, PA
Allwell Medicare Simple is a Medicare Advantage plan, from Allwell, that's available to Medicare beneficiaries living in Berks County, Pennsylvania.
- It's a Health Maintenance Organization (HMO) health plan.
- It offers the same basic benefits as Original Medicare.
- It may offer extras that Medicare does not cover.
- The maximum out-of-pocket cost with this plan is $3,450 .
- The monthly premium is $0.00 (plus your Part B premium).
- NOTE: It does not include a prescription drug plan (Part D).
Allwell Medicare Simple vs. Original Medicare in Berks County
If you join this HMO plan, it will replace your Original Medicare coverage in Berks County and you must agree to let Allwell manage your Medicare benefits, including:
- Medicare Part A (hospital insurance).
- Medicare Part B (medical insurance).
- Additional benefits included in the plan not covered by Medicare.
The benefit of an HMO plan is lower, predictable out-of-pocket expenses. Although more restrictive than Original Medicare, a HMO plan limits your annual out-of-pocket costs. With Medicare Parts A and B, there's no cap, leaving you vulnerable to excessive medical bills.
Allwell Medicare Simple Review
These are the areas of the plan that are important to compare and review:
- Premium: This is the amount you will pay monthly, above and beyond your Medicare Part B.
- Maximum-Out-Of-Pocket (MOOP): This is the most you will pay for co-pays and co-insurance before the plan pays 100%.
- CMS Ratings: Important measurements across 5 different areas that will help you understand how well this plan will care for you.
- Prescription Coverage: Not included with this plan.
- Co-pays & Co-insurance: If you see the doctor regularly, including specialists, you need to know what you'll pay for each visit.
IMPORTANT: With an HMO you are required to use healthcare providers in the plan's network. If you don't you will incur additional costs. Also, be aware that your primary care physician must refer you before you can see a specialist.
NOTE: Allwell Medicare Simple does not include prescription drug coverage (no drug plan). To get it, you can add one of the stand-alone Medicare Drug Plans in Pennsylvania. Prescription drug plans vary widely. Make sure you have the coverage you need.
The monthly premium if you join Allwell Medicare Simple is $0.00 per month. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventative care mandated by CMS (see H2915-010 Summary of Benefits below).
IMPORTANT: When evaluating this plan, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.
Maximum Out-of-Pocket (MOOP) Limit
Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The Allwell Medicare Simple plan MOOP is $3,450 . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.
Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.
NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.
CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medicare Supplement in Berks County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.
For more information about this plan, and other plans on this site, call 1-855-266-4865. You may also contact the plan:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare 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 Advantage program on www.medicare.gov. To learn more about this plan, visit the Allwell Medicare website.
Compare Plan Options
The average Pennsylvania senior compares three or more plan options before making an enrollment decision.
Additional Medicare Plan Options in Berks County
Are you eligible for a Berks County, PA Medicare Special Needs Plan (SNP)? SNPs are a special type of Medicare Advantage plan designed to help people with special needs. Here are some of the SNP plans in your area:
- UPMC for Life Complete Care (Local HMO), for Dual-Eligible beneficiaries
- Geisinger Gold Secure Rx (Local HMO), for Dual-Eligible beneficiaries
- UnitedHealthcare Dual Complete (Local HMO), for Dual-Eligible beneficiaries
- UnitedHealthcare Nursing Home Plan 2 (Local PPO), for Institutional beneficiaries
- Allwell Dual Medicare (Local HMO), for Dual-Eligible beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- Community Blue Medicare PPO Distinct (PPO)
- Geisinger Gold Classic Advantage Rx (HMO)
- AARP Medicare Advantage Patriot (HMO)
- HumanaChoice H5216-120 (PPO)
- Aetna Medicare Advantra Silver Plus (PPO)