Wellcare Giveback Open (PPO)

H8711 - 002 - 0
Plan Not Rated

wellcare medicare provider logo

Wellcare Giveback Open (PPO) is a Medicare Advantage (Part C) Plan by Wellcare.

This page features plan details for 2022 Wellcare Giveback Open (PPO) H8711 – 002 – 0 available in Select counties in NJ.

Locations

Wellcare Giveback Open (PPO) is offered in the following locations.

Plan Overview

Wellcare Giveback Open (PPO) offers the following coverage and cost-sharing.

Insurer: Wellcare
Health Plan Deductible: $0.00
MOOP: $11,300 In and Out-of-network
$7,550 In-network
Drugs Covered: Yes
Please Note:
  • This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.

Ready to sign up for Wellcare Giveback Open (PPO) ?

Get help from a licensed Medicare agent.

Click to Call 1-877-354-4611 TTY 711.
Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Wellcare Giveback Open (PPO) qualifies for a monthly Medicare Give Back Benefit of $60.00.

Premium Reduction:$60.00

Drug Info

Wellcare Giveback Open (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $300.00
Initial Coverage Limit: $4430.00
Catastrophic Coverage Limit: $7050.00
Drug Benefit Type: Enhanced
Gap Coverage: No
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS 25%LIS 50%LIS 75%LIS Full
$0.00$0.00$0.00$0.00$0.00

Initial Coverage Phase

After you pay your $300.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4430.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $4430.00, you will pay no more than the amounts below for any drug tier until you reach $7050.00.

Drug TypeCost Share
Generic drugs25%
Brand-name drugs25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

Drug TypeCost Share
Generic drugs$3.95 copay or 5% (whichever costs more)
Brand-name drugs$9.85 copay or 5% (whichever costs more)

Additional Benefits

Wellcare Giveback Open (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: No

Dental (comprehensive)

Diagnostic services:In-Network: $0 copay (limits may apply) (authorization required)
Diagnostic services:Out-of-Network: $0 copay or 50% coinsurance (limits may apply) (authorization required)
Endodontics: Not covered
Extractions: Not covered
Non-routine services:In-Network: $0 copay (limits may apply) (authorization required)
Non-routine services:Out-of-Network: $0 copay or 50% coinsurance (limits may apply) (authorization required)
Periodontics: Not covered
Prosthodontics, other oral/maxillofacial surgery, other services: Not covered
Restorative services: Not covered

Dental (preventive)

Cleaning:In-Network: $0 copay (limits may apply) (authorization required)
Cleaning:Out-of-Network: $0 copay or 50% coinsurance (limits may apply) (authorization required)
Dental x-ray(s):In-Network: $0 copay (limits may apply) (authorization required)
Dental x-ray(s):Out-of-Network: $0 copay or 50% coinsurance (limits may apply) (authorization required)
Fluoride treatment:In-Network: $0 copay (limits may apply) (authorization required)
Fluoride treatment:Out-of-Network: $0 copay or 50% coinsurance (limits may apply) (authorization required)
Oral exam:In-Network: $0 copay (limits may apply) (authorization required)
Oral exam:Out-of-Network: $0 copay or 50% coinsurance (limits may apply) (authorization required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI):In-Network: $0-350 copay (authorization required)
Diagnostic radiology services (e.g., MRI):Out-of-Network: 50% coinsurance (authorization required)
Diagnostic tests and procedures:In-Network: $0-40 copay (authorization required)
Diagnostic tests and procedures:Out-of-Network: 50% coinsurance (authorization required)
Lab services:In-Network: $0 copay (authorization required)
Lab services:Out-of-Network: 50% coinsurance (authorization required)
Outpatient x-rays:In-Network: $0 copay (authorization required)
Outpatient x-rays:Out-of-Network: 50% coinsurance (authorization required)

Doctor visits

Primary:In-Network: $0 copay
Primary:Out-of-Network: 40% coinsurance per visit
Specialist:In-Network: $50 copay per visit (authorization required)
Specialist:Out-of-Network: 50% coinsurance per visit (authorization required)

Emergency care/Urgent care

Emergency: $90 copay per visit (always covered)
Urgent care: $40 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment:In-Network: $50 copay (authorization required)
Foot exams and treatment:Out-of-Network: 50% coinsurance (authorization required)
Routine foot care: Not covered

Ground ambulance

In-Network: $225 copay
Out-of-Network: $225 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation:In-Network: $0 copay (limits may apply) (authorization required)
Fitting/evaluation:Out-of-Network: 40% coinsurance (limits may apply) (authorization required)
Hearing aids:In-Network: $0 copay (limits may apply) (authorization required)
Hearing aids:Out-of-Network: 40% coinsurance (limits may apply) (authorization required)
Hearing exam:In-Network: $50 copay (authorization required)
Hearing exam:Out-of-Network: 50% coinsurance (authorization required)

Hospital coverage (inpatient)

In-Network: $330 per day for days 1 through 5
$0 per day for days 6 through 90 (authorization required)
Out-of-Network: 20% per day for days 1 through 90 (authorization required)

Hospital coverage (outpatient)

In-Network: $350 copay per visit (authorization required)
Out-of-Network: 50% coinsurance per visit (authorization required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$11,300 In and Out-of-network
$7,550 In-network

Medical equipment/supplies

Diabetes supplies:In-Network: $0 copay per item (authorization required)
Diabetes supplies:Out-of-Network: 50% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):In-Network: 20% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):Out-of-Network: 50% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):In-Network: 20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):Out-of-Network: 50% coinsurance per item (authorization required)

Medicare Part B drugs

Chemotherapy:In-Network: 20% coinsurance (authorization required)
Chemotherapy:Out-of-Network: 40% coinsurance (authorization required)
Other Part B drugs:In-Network: 20% coinsurance (authorization required)
Other Part B drugs:Out-of-Network: 40% coinsurance (authorization required)

Mental health services

Inpatient hospital – psychiatric:In-Network: $1,850 per stay (authorization required)
Inpatient hospital – psychiatric:Out-of-Network: 50% per day for days 1 through 90 (authorization required)
Outpatient group therapy visit with a psychiatrist:In-Network: $25 copay (authorization required)
Outpatient group therapy visit with a psychiatrist:Out-of-Network: 50% coinsurance (authorization required)
Outpatient group therapy visit:In-Network: $25 copay (authorization required)
Outpatient group therapy visit:Out-of-Network: 50% coinsurance (authorization required)
Outpatient individual therapy visit with a psychiatrist:In-Network: $25 copay (authorization required)
Outpatient individual therapy visit with a psychiatrist:Out-of-Network: 50% coinsurance (authorization required)
Outpatient individual therapy visit:In-Network: $25 copay (authorization required)
Outpatient individual therapy visit:Out-of-Network: 50% coinsurance (authorization required)

Optional supplemental benefits

No

Preventive care

In-Network: $0 copay
Out-of-Network: $0 copay

Rehabilitation services

Occupational therapy visit:In-Network: $40 copay (authorization required)
Occupational therapy visit:Out-of-Network: 50% coinsurance (authorization required)
Physical therapy and speech and language therapy visit:In-Network: $40 copay (authorization required)
Physical therapy and speech and language therapy visit:Out-of-Network: 50% coinsurance (authorization required)

Skilled Nursing Facility

In-Network: $0 per day for days 1 through 20
$184 per day for days 21 through 100 (authorization required)
Out-of-Network: 20% per day for days 1 through 100 (authorization required)

Transportation

Not covered

Vision

Contact lenses:In-Network: $0 copay (limits may apply) (authorization required)
Contact lenses:Out-of-Network: 40% coinsurance (limits may apply) (authorization required)
Eyeglass frames:In-Network: $0 copay (limits may apply) (authorization required)
Eyeglass frames:Out-of-Network: 40% coinsurance (limits may apply) (authorization required)
Eyeglass lenses:In-Network: $0 copay (limits may apply) (authorization required)
Eyeglass lenses:Out-of-Network: 40% coinsurance (limits may apply) (authorization required)
Eyeglasses (frames and lenses):In-Network: $0 copay (limits may apply) (authorization required)
Eyeglasses (frames and lenses):Out-of-Network: 40% coinsurance (limits may apply) (authorization required)
Other: Not covered
Routine eye exam:In-Network: $0 copay (limits may apply) (authorization required)
Routine eye exam:Out-of-Network: 40% coinsurance (limits may apply) (authorization required)
Upgrades:In-Network: $0 copay (limits may apply) (authorization required)
Upgrades:Out-of-Network: 40% coinsurance (limits may apply) (authorization required)

Wellness programs (e.g., fitness, nursing hotline)

Covered

Ready to sign up for Wellcare Giveback Open (PPO) ?

Get help from a licensed Medicare agent.

Click to Call 1-877-354-4611 TTY 711.
Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.

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