Wellcare Giveback (HMO-POS)

Inpatient Hospital See details

Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $425 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $400 copay for days 1-5, and no copay for days 6-90. Additional days, and non-Medicare covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services are covered by the Wellcare Giveback (HMO-POS) plan. Outpatient Hospital Services have a copay between $0 and $325, Observation Services have a copay between $110 and $325, Ambulatory Surgical Center (ASC) Services have a $275 copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40, and Outpatient Blood Services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by the Wellcare Giveback (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $80.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Wellcare Giveback (HMO-POS) plan, with a $300 copay for both ground and air ambulance services and no coinsurance. Transportation Services to any health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the Wellcare Giveback (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, and Urgently Needed Services has a $45 copay, while Worldwide Urgent Coverage also has a $110 copay; there is no coinsurance for any of these services, but Worldwide Emergency Transportation is not covered.

Primary Care See details

The Wellcare Giveback (HMO-POS) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Occupational therapy services, physical therapy and speech-language pathology services, and physician specialist services each have a $30 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, and opioid treatment program services all have varying copays. Additional telehealth benefits have a copay between $0 and $45.

Preventive Services See details

Preventive services include an annual physical exam with no copay, as well as additional services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, each with no copay. Kidney Disease Education Services have a 20% coinsurance. Some additional preventive services, such as Health Education, are not covered.

Hearing Services See details

Hearing services include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for a hearing aid with no copay. Prescription hearing aids are covered with a $500 maximum plan benefit per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.

Vision Services See details

The Wellcare Giveback (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $30, and eyewear has no copay, with a combined maximum benefit of $100 per year.

Dental Services See details

The Wellcare Giveback (HMO-POS) plan covers Medicare Dental Services with a $30 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments have no copay. Restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery have 20% coinsurance. The plan does not cover prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. The plan covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered under the Wellcare Giveback (HMO-POS) plan. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance; Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic procedures/tests have a copay between $0 and $30, while lab services have no copay.

Radiological services, including diagnostic and therapeutic radiological services and outpatient X-ray services, are also covered; diagnostic radiological services have a copay up to $325, therapeutic radiological services have a coinsurance of 20% at minimum, and outpatient X-ray services have a $25 copay.

Home Health Services See details

Home Health Services are covered by the Wellcare Giveback (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the Wellcare Giveback (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered under the Wellcare Giveback (HMO-POS) plan. For days 1-20, there is no copay; for days 21-70, the copay is $214, and for days 71-100, there is no copay.

Other Services See details

Other Services includes acupuncture, which has no copay, but requires prior authorization and is limited to 12 treatments per year. Over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.