Wellcare Specialty No Premium (C-SNP HMO), Maricopa County, AZ
Wellcare Specialty No Premium (Plan ID: H0351-038) is a 2023 Medicare Special Needs Plan (C-SNP) for people who live in Maricopa County, Arizona. This Wellcare by Allwell HMO plan is required to provide all of the same benefits as Original Medicare and includes some additional benefits, but out-of-pocket costs may be different.
CMS rated this plan 2.5 (Below Average) out of 5 stars.
GET NOTIFIED: 2024 Medicare Special Needs Plan Notification.
What You Need to Know
- Wellcare Specialty No Premium is a non-government health plan that restricts enrollment to special needs individuals with specific severe or disabling chronic conditions.
- This plan is for individuals with chronic alcohol and other drug dependence.
- In addition to the chronic health condition(s) above, you must have both Medicare Part A and Part B, and you must live in the plan's service area (Maricopa County).
- The plan has a HMO provider network, and it includes prescription drug coverage (Medicare Part D).
- The Part D plan does not have an annual deductible. Cost-sharing begins with your first prescription.
- As required, Wellcare Specialty No Premium has the same core benefits as Original Medicare but offers additional benefits not available in Original Medicare.
- The out-of-pocket costs with this plan are different than Original Medicare and, in some cases, may be higher. Review the "Health Plan Costs & Benefits" section below for the most used services.
- 2024 costs and benefits for Wellcare Specialty No Premium will be available in early October. Get Notification.
| H0351-038-0 Plan Basics | |
|---|---|
| Plan ID: | H0351-038-0 |
| Plan Type: | C-SNP |
| Network Type: | HMO |
| Plan Year: | 2023 |
| Premium: | $0.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $5,500 In-network |
| Drug Plan Benefit: | Enhanced $0.00 deductible |
| Rx Gap Coverage: | Yes |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Maricopa County, AZ |
| Insured By: | Wellcare by Allwell |
Health Plan Costs & Benefits
Wellcare Specialty No Premium is a Health Maintenance Organization (HMO) plan. HMO 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.
Premiums, deductibles, and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.
Monthly Premium
Wellcare Specialty No Premium's total monthly premium in Maricopa County is $0.00. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Annual Deductible
Wellcare Specialty No Premium's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.
Maximum Out-of-Pocket Limit
The Maximum Out-of-Pocket (MOOP) with this Wellcare by Allwell plan is $5,500 in-network. Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copayments, all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.
Health Plan Out-of-Pocket Costs
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 |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $5,500 In-network |
| Doctor Visits | |
| Specialist | $15 copay per visit (authorization required) |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient group therapy visit | $15 copay (authorization required) |
| Outpatient individual therapy visit | $15 copay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist | $15 copay (authorization required) |
| Inpatient hospital - psychiatric | $250 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) |
| Rehabilitation Services | |
| Occupational therapy visit | $15 copay (authorization required) |
| Medical Equipment / Supplies | |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (authorization required) |
| Diabetes supplies | $0 copay (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Outpatient x-rays | $0 copay (authorization required) |
| Diagnostic tests and procedures | $0 copay (authorization required) |
| Lab services | $0 copay (authorization required) |
| Medicare Part B Drugs | |
| Other Part B drugs | 20% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Routine foot care | $15 copay (authorization required) |
| Hearing | |
| Hearing exam | $15 copay (referral required, authorization required) |
| Fitting/evaluation | $0 copay (referral required, authorization required, limits may apply) |
| Preventive Dental | |
| Oral exam | $0 copay (authorization required, limits may apply) |
| Fluoride treatment | $0 copay (authorization required, limits may apply) |
| Cleaning | $0 copay (authorization required, limits may apply) |
| Comprehensive Dental | |
| Restorative services | 40% coinsurance (authorization required, limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services | 40% coinsurance (authorization required, limits may apply) |
| Diagnostic services | 40% coinsurance (authorization required, limits may apply) |
| Non-routine services | 40% coinsurance (authorization required, limits may apply) |
| Periodontics | 40% coinsurance (authorization required, limits may apply) |
| Endodontics | 40% coinsurance (authorization required, limits may apply) |
| Vision | |
| Contact lenses | $0 copay (referral required, authorization required, limits may apply) |
| Eyeglass lenses | $0 copay (referral required, authorization required, limits may apply) |
| Upgrades | $0 copay (referral required, authorization required, limits may apply) |
| Routine eye exam | $0 copay (referral required, authorization required, limits may apply) |
| Other | Not covered |
| Eyeglasses (frames and lenses) | $0 copay (referral required, authorization required, limits may apply) |
| Emergency Care / Urgent Care | |
| Urgent care | $10 copay per visit (always covered) |
| Ground ambulance | $285 copay |
| Inpatient hospital coverage | $250 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 through 210 |
| Outpatient hospital coverage | $250 copay per visit |
| Skilled Nursing Facility | $0 per day for days 1 through 20 $196 per day for days 21 through 50 $0 per day for days 51 through 100 |
| Optional supplemental benefits | No |
Feel free to download our Wellcare Specialty No Premium Summary of Benefits information.
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.
Enhanced plans generally have higher monthly premiums than basic benefit plans but offer more benefits. For example, many enhanced PDPs do not have an annual deductible, may offer additional coverage during the coverage gap (aka, "donut hole"), and may have a broader list of supported drugs, known as a formulary. Some enhanced PDPs even cover excluded drugs. It's important to remember that benefits vary from plan to 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 prescription drug plan premium details of this plan.
| Basic Part D Premium: | -$31.30 |
| Supplemental Part D Premium: | $31.30 |
| Total Part D Premium: | $0.00 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $0.00 |
| Part D Premium with 50% LIS Assistance: | $0.00 |
| Part D Premium with 25% LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
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 copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $5.00 copay |
| 2 (Generic) | $5.00 copay | $10.00 copay |
| 3 (Preferred Brand) | $37.00 copay | $47.00 copay |
| 4 (Non-Preferred Drug) | $90.00 copay | $100.00 copay |
| 5 (Specialty Tier) | 33% | 33% |
| 6 (Select Diabetic Drugs) | $0.00 copay | $0.00 copay |
CMS Rating Marks and Our Review
Each year Medicare rates C-SNP plans, like this one, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join Wellcare Specialty No Premium.
Think twice before joining this sub-par Medicare Advantage plan. From MedicareWire's perspective, Wellcare Specialty No Premium does an average job keeping plan members healthy through preventive care measures, including screenings, tests, and vaccines. When it comes to helping members manage their chronic health conditions, this plan does an average job. Sadly, the overall member experience with this Wellcare by Allwell C-SNP plan is poor. When it comes to complaints and changes in performance, this plan is below average. Not the best or the worst when it comes to customer service, this health plan's customer service is average.
| CMS Measure | Star Rating |
|---|---|
| 2023 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 | Not enough data available |
| 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 chronic alcohol and other drug dependence.
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Wellcare by Allwell
Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent (Mon-Fri, 8am-9pm , Sat 8am-8pm EST) and learn more about this Special Needs Plan and other plans on this site. You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
| Plan Website: | http://www.wellcare.com/allwellAZ |
|---|---|
| Formulay Information: | http://www.wellcare.com/allwellAZ |
| Pharmacy Information: | Wellcare by Allwell Pharmacy Page |
| Prospective Members: | (866)277-6583 |
| TTY Users: | (711)- |
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.
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, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.
Citations & References
- Wellcare by Allwell, http://www.wellcare.com/allwellAZ, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Arizona", Last Accessed January 20, 2023
- CMS.gov, "Chronic Condition Special Needs Plans (C-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 21, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 21, 2023
- CMS.gov, Plan Benefits Package, Last Accessed January 21, 2023