Wellcare Patriot Giveback (HMO-POS) 2024 Benefit Details for Plan H1416-058-0 by Wellcare
Wellcare Patriot Giveback is a 2024 HMO-POS Medicare Advantage plan {with_without_pdp} prescription drug plan benefits (Part D).
This Wellcare option offers the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may also include additional, valuable benefits not covered by Part A or Part B.
Plan Basics | |
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Plan ID: | H1416 058 0 |
Plan Type: | Local HMO |
Plan Year: | 2024 |
Premium: | $0.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $4,500/yr |
Part B Reduction: | $50.00/mo |
Drug Plan Benefit: | Not Included |
Rx Gap Coverage: | No |
Supplemental Benefits: | Dental, Vision, Hearing |
Availability: | See List |
Insured By: | Wellcare |
Summary of Benefits |
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Health Plan Cost Sharing
This Wellcare Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | $35 Copay Authorization Required |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $35 Copay Authorization Required |
Routine foot care: | Not Covered |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $20 Copay Authorization Required |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $120 Copay |
Urgent care: | $35 Copay |
Ground ambulance: | $200 Copay |
Inpatient hospital coverage: | $350.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital coverage: | $100 Copay Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 through 50 $0.00 per day for days 51 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $40 Copay |
Outpatient group therapy visit with a psychiatrist: | $40 Copay |
Inpatient hospital - psychiatric: | $325.00 per day for days 1 through 4 $0.00 per day for days 5 and beyond |
Outpatient group therapy visit: | $40 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $35 Copay Authorization Required |
Occupational therapy visit: | $35 Copay Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Authorization Required |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $150 Copay Authorization Required |
Lab services: | $50 Copay Authorization Required |
Outpatient x-rays: | $0 Copay Authorization Required |
Diagnostic tests and procedures: | $20 Copay Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Wellcare Patriot Giveback Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Wellcare includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | Maximum dental benefit: | Non Specified |
Oral exam (In-Network) | Covered |
Fluoride treatment (In-Network) | Covered |
Dental x-ray(s) (In-Network) | Covered |
Cleaning (In-Network) | Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Covered |
Non-routine services (In-Network) | Covered |
Diagnostic services (In-Network) | Covered |
Extractions (In-Network) | Covered |
Endodontics (In-Network) | Covered |
Restorative services (In-Network) | Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay Authorization Required |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay Authorization Required |
Vision | Maximum vision benefit: | $200.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay Authorization Required |
Contact lenses (In-Network) | $0 Copay |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Marks
The following table shows the quality ratings for this Wellcare plan. Each year CMS rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories based on a 5-star rating system. Here are the most recent ratings for Wellcare Patriot Giveback.
CMS Measure | Star Rating |
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2024 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 |
Most Medicare Advantage HMO-POS plans get average marks, including this one. Wellcare Patriot Giveback does an average job keeping its members healthy through preventive health measures, including screenings, tests, and vaccines. This plan is below average at managing chronic (long-term) health conditions.
Medicare beneficiaries enrolled in this Wellcare plan enjoy a good member experience. Complaints and changes in plan performance are one way we can measure quality, and this plan scores good at both. Not the best or the worst when it comes to customer service, this health plan's customer service is average.
Beneficiaries searching for top value will find dental, vision, and hearing benefits available with this Medicare Advantage plan (limitations apply).
No additional monthly premium with this plan is a potential savings opportunity for healthy individuals. If you're looking for all the savings you can get, this Local HMO plan has a Part B reduction benefit, often called a giveback, of $50.00 per month. While not the lowest, Wellcare Patriot Giveback's maximum out-of-pocket (MOOP) limit ($4,500/yr) won't cost you more than Original Medicare for a 5-day stay in the hospital. This health plan does not have an annual deductible, making health care a little easier to budget.
Plan Availability
Wellcare Patriot Giveback (H1416-058-0) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H1416-042-0: Wellcare Assist (HMO)
- H1416-009-0: Wellcare No Premium (HMO-POS)
- H1416-071-0: Wellcare No Premium (HMO)
- H1416-079-0: Wellcare Giveback (HMO)
- H1416-041-0: Wellcare Assist Compass (HMO)
Contact Wellcare
Plan Website: | http://www.wellcare.com |
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Formulary Information: | http://www.wellcare.com |
Pharmacy Information: | Wellcare Pharmacy Page |
Prospective Members: | (844)917-0175 |
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 Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Wellcare, http://www.wellcare.com, Last Accessed February 20, 2024
- Medicare.gov, "Your health plan options", Last Accessed February 20, 2024
- Medicare.gov, "How Original Medicare Works", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You Handbook", Last Accessed February 19, 2024
- Medicare.gov, "What Medicare Covers", Last Accessed February 7, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H1416-058-0 Plan Detail Page
The data on this Wellcare Patriot Giveback plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by Wellcare to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from Wellcare, at (844)917-0175, prior to enrollment.