Wellcare Specialty No Premium (C-SNP) Plan Details for Maricopa County, AZ
This Wellcare by Allwell plan has an overall rating of 3.0 (Average) out of 5 stars.
Wellcare Specialty No Premium (C-SNP HMO) is a Medicare Special Needs Plan (SNP). Enrollment for 2025 starts Oct 15. Get notified.
Delivery of healthcare services and costs by Wellcare by Allwell differs from Original Medicare. This private health insurance option may include additional benefits that are not provided by Medicare Part A and Part B.
Only individuals who meet all qualification requirements can join this Wellcare by Allwell C-SNP plan.
2025 Wellcare Specialty No Premium Cost and Coverage Notification
The 2025 cost and coverage information for Wellcare Specialty No Premium will not be available until early October. We'll notify you when it is available from CMS.
Sign-Up for 2025 Medicare Plan Notification. The 2025 enrollment period begins October 15.
| Plan Basics | |
|---|---|
| Plan ID: | H0351-038-0 |
| Plan Type: | HMO |
| Plan Year: | 2024 |
| Premium: | $0.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | /yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Enhanced $0.00 deductible |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Maricopa County, AZ |
| Insured By: | Wellcare by Allwell |
| Summary of Benefits |
|---|
Health Plan Cost Sharing & Benefits
Wellcare Specialty No Premium is a Health Maintenance Organization (HMO) plan. HMO C-SNP plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Wellcare Specialty No Premium does allow out-of-network care for emergencies and out-of-area dialysis.
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Wellcare by Allwell plan:
| Healthcare Service | Member Cost |
|---|---|
| Doctor Visits (In-Network) | |
| Primary: | $0 Copay |
| Specialist: | $15 Copay Prior Authorization Required |
| Wellness programs (e.g., fitness, nursing hotline): | |
| Preventive care: | $0 Copay |
| Foot Care (In-Network) | |
| Foot exams and treatment (Medicare-covered): | $15 Copay Prior Authorization Required |
| Routine foot care: | $15 Copay Prior Authorization Required |
| Chiropractic Care (In-Network) | |
| Medicare-covered chiropractic care: | $15 Copay Prior Authorization Required |
| Routine chiropractic care: | $15 Copay Prior Authorization Required |
| Emergency Care / Urgent Care | |
| Emergency room care: | $135 Copay |
| Urgent care: | $10 Copay |
| Ground ambulance: | $285 Copay |
| Inpatient hospital coverage: | $250.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Outpatient hospital coverage: | $250 Copay Prior 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: | Not Covered |
| Mental Health Services (In-Network) | |
| Outpatient individual therapy visit with a psychiatrist: | $15 Copay |
| Outpatient group therapy visit with a psychiatrist: | $15 Copay |
| Inpatient hospital - psychiatric: | $250.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Outpatient group therapy visit: | $15 Copay |
| Outpatient individual therapy visit: | $0 |
| Rehabilitation Services (In-Network) | |
| Physical therapy and speech and language therapy visit: | $15 Copay Prior Authorization Required |
| Occupational therapy visit: | $15 Copay Prior Authorization Required |
| Medical Equipment / Supplies (In-Network) | |
| Diabetes supplies: | $0 Copay Prior Authorization Required |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
| Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
| Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
| Diagnostic radiology services (e.g., MRI): | $250 Copay Prior Authorization Required |
| Lab services: | $50 Copay Prior Authorization Required |
| Outpatient x-rays: | $0 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $0 Copay Prior 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 Specialty No Premium Summary of Benefits information.
Supplemental Health Plan Benefits (H0351-038-0)
The following is a summary of the supplemental benefits Wellcare by Allwell includes with this plan:
| Supplemental Healthcare Service | Member Cost |
|---|---|
| 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 | |
| Fitting/evaluation (In-Network) | $0 Copay Prior Authorization Required |
| Hearing aids (In-Network) | Covered Limits may apply |
| Hearing exam (In-Network) | $0 Copay Prior Authorization Required |
| Vision | Maximum vision benefit: | $100.00 Every year |
| Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
| Routine eye exam (In-Network) | $0 Copay Prior Authorization Required |
| Contact lenses (In-Network) | $0 Copay |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Wellcare Specialty No Premium includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the details of this plan's prescription drug plan premium.
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Part D Premium with Full LIS Assistance: | $0.00 |
The Social Security Extra Help page has more information about the low-income subsidy (LIS) and how to enroll in the program.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before Wellcare by Allwell begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Wellcare Specialty No Premium has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $5.00 copay |
| 2 (Generic) | $4.00 copay | $7.00 copay |
| 3 (Preferred Brand) | $42.00 copay | $47.00 copay |
| 4 (Non-Preferred Drug) | 37% | 37% |
| 5 (Specialty Tier) | 33% | 33% |
| 6 (Select Care Drugs) | $0.00 copay | $0.00 copay |
5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage C-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this Wellcare by Allwell plan.
| CMS Measure | Star Rating |
|---|---|
| 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 |
How to Qualify to Enroll in
Wellcare Specialty No Premium
To be eligible to enroll in Wellcare Specialty No Premium, you must meet these requirements:
- You are eligible for Medicare;
- You live in Maricopa County (the plan’s service area); and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabiling chronic condition (disease) is one that lasts one or more years and requires ongoing medical attention and/or limits activities of daily living. They include:
- Autoimmune disorders
- End-stage renal disease
- Cancer
- Cardiovascular disorders
- Hematologic disorders
- HIV/AIDS
- Chronic heart failure
- Chronic lung disorders
- Neurologic disorders
- Dementia
- Diabetes
- End-stage liver disease
- Neurologic disorders
- Stroke
- Mental health conditions
This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes.
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- None.
Contact Wellcare by Allwell
| Plan Website: | http://www.wellcare.com/allwellAZ |
|---|---|
| Formulay Information: | http://www.wellcare.com/allwellAZ |
| Pharmacy Information: | Wellcare by Allwell 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.
Health Plan Compatibility
Medicare Advantage Special Need Plans are not compatible with most other forms of health insurance. If you have Medicare Part A and/or Medicare Part B and join a SNP plan, you will be disenrolled from Original Medicare. You cannot simultaneously enroll in an SNP plan and Medicare Supplement Insurance.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- Wellcare by Allwell, http://www.wellcare.com/allwellAZ, Last Accessed October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in Arizona", Last Accessed January 4, 2024
- CMS.gov, "Chronic Condition Special Needs Plans (C-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed January 3, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.