Wellcare Dual Access Medicare (D-SNP HMO), Washington Parish, LA
Wellcare Dual Access Medicare, plan H5117-004-0, is a D-SNP Medicare Advantage plan, by Wellcare by Allwell. It has a HMO provider network. Delivery of healthcare services and costs are significantly different than in Original Medicare, and the plan offers additional benefits that are not included with Medicare Part A and Part B.
This plan is rated 2.5 (Below Average) stars by CMS. See MedicareWire's review below. You must meet all qualification requirements to join this D-SNP plan.
GET NOTIFIED: 2024 Medicare Special Needs Plan Notification.
What You Need to Know
- This is a Medicare Special Needs Plan, with a HMO provider network, exclusively for people with Medicare and Medicaid benefits (dual-eligible).
- This is a zero-dollar D-SNP cost-sharing plan. Members have no copays when they use Medicare-approved healthcare services.
- To qualify, you must live in Washington Parish and have both Medicare Part A and Part B. Plus, you must qualify for full Medicaid.
- Wellcare Dual Access Medicare includes a Medicare Part D prescription drug plan.
- The annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
- If you qualify for the Social Security "Extra Help" program, you can get financial assistance to help pay your Medicare Part D monthly premium, annual deductible, and prescription copayments.
- Wellcare Dual Access Medicare provides the same coverage benefits as Medicare Part A and Part B (Original Medicare) and includes some extra benefits not covered by Original Medicare.
- If you are not qualified to enroll, one of the traditional Medicare Advantage plans available in Washington Parish, Louisiana might be your best option.
- 2024 costs and benefits for Wellcare Dual Access Medicare will be available in early October. Get Notification.
| H5117-004-0 Plan Basics | |
|---|---|
| Plan ID: | H5117-004-0 |
| Plan Type: | D-SNP |
| Network Type: | HMO |
| Plan Year: | 2023 |
| Premium: | $26.10/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $8,300 In-network |
| Drug Plan Benefit: | Basic $505.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Washington Parish, LA |
| Insured By: | Wellcare by Allwell |
Health Plan Costs & Benefits
Wellcare Dual Access Medicare 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 Dual Access Medicare 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 Dual Access Medicare's total monthly premium in Washington Parish is $26.10. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Annual Deductible
Wellcare Dual Access Medicare'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 $8,300 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) | $8,300 In-network |
| Doctor Visits | |
| Specialist | $0 copay (authorization required) |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient individual therapy visit | $0 copay (authorization required) |
| Outpatient group therapy visit | $0 copay (authorization required) |
| Inpatient hospital - psychiatric | $0 copay (authorization required) |
| Outpatient group therapy visit with a psychiatrist | $0 copay (authorization required) |
| Rehabilitation Services | |
| Occupational therapy visit | $0 copay (authorization required) |
| Medical Equipment / Supplies | |
| Prosthetics (e.g., braces, artificial limbs) | $0 copay (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Diagnostic tests and procedures | $0 copay (authorization required) |
| Lab services | $0 copay (authorization required) |
| Outpatient x-rays | $0 copay (authorization required) |
| Medicare Part B Drugs | |
| Chemotherapy | $0 copay (authorization required) |
| Foot Care (podiatry Services) | |
| Foot exams and treatment | $0 copay (authorization required) |
| Hearing | |
| Hearing exam | $0 copay (referral required, authorization required) |
| Fitting/evaluation | $0 copay (referral required, authorization required, limits may apply) |
| Preventive Dental | |
| Dental x-ray(s) | $0 copay (authorization required, limits may apply) |
| Cleaning | $0 copay (authorization required, limits may apply) |
| Fluoride treatment | $0 copay (authorization required, limits may apply) |
| Comprehensive Dental | |
| Endodontics | $0 copay (authorization required, limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (authorization required, limits may apply) |
| Restorative services | $0 copay (authorization required, limits may apply) |
| Periodontics | $0 copay (authorization required, limits may apply) |
| Diagnostic services | $0 copay (authorization required, limits may apply) |
| Non-routine services | $0 copay (authorization required, limits may apply) |
| Vision | |
| Other | Not covered |
| Upgrades | $0 copay (referral required, authorization required, limits may apply) |
| Eyeglass lenses | $0 copay (referral required, authorization required, limits may apply) |
| Contact lenses | $0 copay (referral required, authorization required, limits may apply) |
| Eyeglass frames | $0 copay (referral required, authorization required, limits may apply) |
| Routine eye exam | $0 copay (referral required, authorization required, limits may apply) |
| Emergency Care / Urgent Care | |
| Emergency | $0 copay |
| Ground ambulance | $0 copay |
| Inpatient hospital coverage | $0 copay |
| Outpatient hospital coverage | $0 copay |
| Skilled Nursing Facility | $0 copay |
| Optional supplemental benefits | No |
Feel free to download our Wellcare Dual Access Medicare Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
Wellcare Dual Access Medicare includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Basic plans typically have less cost-sharing by the plan than plans with an enhanced benefit. But, close to a third of all enhanced plans charge more than the average for preferred brand name drugs, and over 50% charge more for non-preferred brand drugs. For most people, a basic plan is their best bet, due to lower premiums and lower cost-sharing, even if the plan has a deductible.
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: | $26.10 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $26.10 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $6.50 |
| Part D Premium with 50% LIS Assistance: | $13.00 |
| Part D Premium with 25% LIS Assistance: | $19.60 |
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 $505.00. 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 Dual Access Medicare 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 |
|---|---|---|
| $0 copay on all covered generic and brand-name prescriptions. | ||
A Brief Review and CMS 5-Star Rating Marks
The table below shows the quality ratings for this Wellcare by Allwell plan. Each year CMS rates Medicare Special Needs Plans in nine broad categories. We do not recommend joining a plan with an overall rating of less than 3.0 (3 stars).
Way below Louisiana standards, we can't recommend this plan. Here's why. From MedicareWire's viewpoint, anyone looking for a D-SNP HMO plan that prioritizes preventive health (i.e., screenings, tests, vaccines, etc.) may be disapointed with Wellcare Dual Access Medicare because the plan's score is below average. This plan is good at managing its member's chronic (long-term) health conditions. We do not have enough information from this plan to rate member experience. When it comes to complaints and changes in performance, this plan is below average.
| CMS Measure | Star Rating |
|---|---|
| 2023 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Not enough data available |
| 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 Dual Access Medicare
To qualify for enrollment in Wellcare Dual Access Medicare in Washington Parish, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Louisiana's state thresholds.
Before enrolling in Wellcare Dual Access Medicare, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- Aetna Medicare Dual Select Plan
- Aetna Medicare Dual Preferred Plan
- HumanaChoice SNP-DE H5216-332
- Humana Gold Plus SNP-DE H1951-057
- Peoples Health Secure Complete
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/allwellLA |
|---|---|
| Formulay Information: | http://www.wellcare.com/allwellLA |
| 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/allwellLA, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Louisiana", Last Accessed January 20, 2023
- CMS.gov, "Dual Eligible Special Needs Plans (D-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