WellSense Senior Care Options (D-SNP) Plan Details for Barnstable County, MA
This page provides coverage and cost details for WellSense Health Plan’s H9585-001-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*CMS rated this WellSense Health Plan plan (H9585-001-0) 3.5 (Above Average) out of 5 stars.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Dual-Eligible SNP qualification requirements to join this D-SNP plan.
WellSense Senior Care Options Basic Plan Details
- Plan ID
- H9585-001-0
- Plan Type
- HMO D-SNP
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 7,100.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Basic
$590.00 deductible - Supplemental Benefits
- None
- Availability
- Barnstable County, MA
- Insured By
- WellSense Health Plan
| Summary of 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 WellSense Health Plan plan:
Doctor's Office Visits
- Primary
- $0 Copay
- Specialist
- $0 Copay
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $0 Copay
- Urgent care
- $0 Copay
- Ground ambulance
- $0 Copay
- Inpatient hospital care
- Coming Soon
- Skilled Nursing Facility
- Unknown
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $0 Copay
- Routine Foot Care
- $0 Copay
Chiropractic Care
- Medicare-covered chiropractic
- $0 Copay
- Routine chiropractic
- $0 Copay
Mental Health Services
- Outpatient individual therapy
- $0 Copay
- Outpatient group therapy
- $0 Copay
- Inpatient psychiatric hospital care
- Coming Soon
Rehabilitation Services
- Physical therapy and speech and language therapy
- $0 Copay
Prior Authorization Required - Occupational therapy
- $0 Copay
Prior Authorization Required
Medical Equipment and Supplies
- Diabetes supplies
- $0 Copay
Prior Authorization Required - Durable medical equipment
- $0 Copay
Prior Authorization Required - Prosthetics
- $0 Copay
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $0 Copay
Prior Authorization Required - Lab services
- $0 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
- Chemotherapy
- $0 Copay
- Other Part B drugs (Medicare-covered)
- $0 Copay
Dental Services
- Medicare Covered Preventive Dental
- 20% Coinsurance
- Oral exam
- Not Covered
- Dental x-rays
- Not Covered
- Cleaning
- Not Covered
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
Hearing Aids and Services
- Fitting/evaluation
- Not Covered
- Hearing aids
- Not Covered
- Hearing exam
- Not Covered
Vision Services
- Medicare-covered eye exam
- 20% Coinsurance
- Routine eye exam
- Not Covered
- Eyewear benefits
- None
Prescription Drug Costs & Benefits
WellSense Senior Care Options 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.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $52.50 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before WellSense Health Plan begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, WellSense Senior Care Options has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Cost data not available. | ||
| *The Part D deductible does not apply. | ||
5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage D-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 WellSense Health Plan plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 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 | Not enough data available |
| 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
WellSense Senior Care Options
To qualify for enrollment in WellSense Senior Care Options in Barnstable County, 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 Massachusetts's state thresholds.
Before enrolling in WellSense Senior Care Options , 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:
Contact Us About WellSense Health Plan
| Website: | WellSense Health Plan Plan Page (opens in new tab) |
|---|---|
| Providers: | WellSense Health Plan Providers Page (opens in new tab) |
| Formulary: | WellSense Health Plan Formulary Page (opens in new tab) |
| Pharmacy: | WellSense Health Plan Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (855)833-8124 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (855)833-8124 |
| New Member Part D 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
Special Needs Plans (SNPs) under Medicare Advantage typically do not work with other types of health insurance. If you have Medicare Part A or Part B and decide to join an SNP plan, you will be removed from Original Medicare. Furthermore, you cannot be enrolled in an SNP plan and hold a Medigap Insurance policy at the same time.
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
- WellSense Health Plan, http://wellsense.org/sco, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in Massachusetts", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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