Wellcare Dual Pinnacle is a 2022 D-SNP Medicare Special Needs Plan, from WellCare, available in Lafourche Parish, Louisiana.
- It's a Local HMO health plan.
- It includes prescription drug coverage (Medicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each...).
- It offers the same health insurance benefits as Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage..
- It offers extras that Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. do not cover.
- Most of the costs (e.g., A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.) to be in this Medicare Special Needs Plan will be covered for you.
How to Qualify to Enroll in Wellcare Dual Pinnacle
If you qualify and enroll, this Local HMO plan replaces your Original Medicare coverage. To qualify, you must meet the following criteria:
- You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
- You live in the plan's service area.
- You have both Medicare and Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States..
If you're not sure if you qualify for both Medicare and Medicaid, contact your local Medicaid office.
IMPORTANT: If you qualify for this plan based on your dual eligibility status, but you also have one or more chronic conditions, you should also investigate C-SNP plans in your areas, as they may offer a care manager to help coordinate your healthcare needs.
If you don't qualify to join this plan, you might want to compare Medicare Advantage plans in Lafourche Parish, Louisiana. Another popular option is to add a Louisiana Medicare supplement plan and a stand-alone Louisiana Medicare prescription drug plan.
Before Joining Wellcare Dual Pinnacle, Consider These Questions:
- Does the plan coordinate my Medicare and Medicaid benefits to make them easily accessible?
- What costs should I expect for my coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket expenses?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's Doctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... 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 plan's A formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.?
- What special accommodations does the plan make for persons with disabilities?
- What special language and cultural accommodations does the plan make?
How Much Does Wellcare Dual Pinnacle Cost?
The premium on this plan is $33.80 per month. That includes your prescription drugs, as well. Plus, you must continue to pay your monthly The Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above.... Copayments and/or coinsurances also apply with most healthcare services, except preventive care mandated by CMS.
Although the health plan itself does not have a deductible, the prescription drug plan does. It's $480.00 per year. That means you pay 100% of your prescription costs until you've spent $480.00, then the plan will begin paying it's share.
Medicare 5-Star Ratings
In this section we show you the quality rating 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. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this health plan.
Wellcare Dual Pinnacle Medicare Part D Co-Pays
This SNP plan includes prescription drug coverage (Medicare Part D). If you have regular prescriptions, it's critical that you evaluate your costs using the plan's formulary.
In addition to the monthly premium and Part D deductible, the drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the drug coverage schedule for this plan:
|1 (Preferred Generic)||N/A||$0.00 copay|
|2 (Generic)||N/A||$6.00 copay|
|3 (Preferred Brand)||N/A||$42.00 copay|
|4 (Non-Preferred Drug)||N/A||50%|
|5 (Specialty Tier)||N/A||25%|
|6 (Select Care Drugs)||N/A||$0.00 copay|
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 (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). program on www.medicare.gov. To learn more about this plan, visit the WellCare Medicare website.
Wellcare Dual Pinnacle is available to beneficiaries living in Thibodaux, Cut Off, Galliano, Gheens, Golden Meadow, Kraemer, Larose, Lockport, Mathews, Raceland, and all other areas of Lafourche Parish, Louisiana; Medicare plans are the same throughout the Parish.
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