Wellcare Fidelis Dual Access (HMO D-SNP)

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and have a copay of $1940 per admission or stay. Additional days, non-Medicare stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a 20% coinsurance and no copay, while Observation Services have a 20% coinsurance. Individual and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance, and Outpatient Blood Services have a 20% coinsurance.

Partial Hospitalization See details

Partial Hospitalization is covered under the Wellcare Fidelis Dual Access (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.

Ambulance and Transportation Services See details

The Wellcare Fidelis Dual Access (HMO D-SNP) plan covers ambulance services with no copay and 20% coinsurance for both ground and air ambulance services, and the coinsurance is waived if admitted to the hospital. Transportation services to any health-related location are not covered.

Emergency Services See details

Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered under this plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Worldwide Urgent Coverage also has a $110 copay.

Urgently Needed Services are covered with a $45 copay, and Worldwide Emergency Transportation is not covered.

Primary Care See details

Primary Care services include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Chiropractic Services do not cover routine care, and Podiatry Services are not covered. Additional Telehealth Benefits also have a copay between $0 and $45.

Preventive Services See details

Preventive Services include Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Alternative Therapies, all with no copay. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.

Hearing Services See details

Hearing services include hearing exams, covered with at most 20% coinsurance for routine hearing exams, and no copay for routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a maximum benefit of $350 per ear, and no copay for prescription hearing aids (all types). OTC hearing aids, and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.

Vision Services See details

Vision services include coverage for eye exams and eyewear, with a 20% coinsurance for eye exams and eyewear, and no copay for eye exams. Routine eye exams have no copay and are limited to one visit per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum plan benefit coverage of $100 per year.

Dental Services See details

Dental services are covered, including Medicare Dental Services with 20% coinsurance. Other dental services are covered, with no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery. Orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered by the Wellcare Fidelis Dual Access (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered by the Wellcare Fidelis Dual Access (HMO D-SNP) plan. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 20% coinsurance for some services. Durable Medical Equipment for use outside the home is not covered.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, and radiological services. Diagnostic Procedures/Tests and Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%.

Home Health Services See details

Home Health Services are covered by the Wellcare Fidelis Dual Access (HMO D-SNP) plan with no copay and no coinsurance, although 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 Fidelis Dual Access (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Wellcare Fidelis Dual Access (HMO D-SNP) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.

Other Services See details

The Wellcare Fidelis Dual Access (HMO D-SNP) plan covers over-the-counter (OTC) items and meal benefits. OTC items have no copay, while meal benefits require a doctor's referral and have no copay. Acupuncture, 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.