Wellcare Patriot Giveback (HMO)

H2915 - 013 - 0
3.5 out of 5 stars (3.5 / 5)

Wellcare Patriot Giveback (HMO) is a Medicare Advantage (Part C) Plan by Wellcare by Allwell.

This page features plan details for 2024 Wellcare Patriot Giveback (HMO) H2915 – 013 – 0 available in Select counties in PA.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

Wellcare Patriot Giveback (HMO) is offered in the following locations.

Plan Overview

Wellcare Patriot Giveback (HMO) offers the following coverage and cost-sharing.

Insurer:Wellcare by Allwell
Health Plan Deductible:$0.00
MOOP:$7,550 In-network
Drugs Covered:No

Ready to sign up for Wellcare Patriot Giveback (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

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 Patriot Giveback (HMO) qualifies for a monthly Medicare Give Back Benefit of $65.00.

Premium Reduction:$65.00

Premium Breakdown

Wellcare Patriot Giveback (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$174.70 $0.00 $65.00 $109.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Wellcare Patriot Giveback (HMO) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

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

$7,550 In-network

Optional supplemental benefits

No

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

In-network No

Outpatient hospital coverage

$0-350 copay per visit (Authorization is required.) (Referral is not required.)

Doctor visits

Primary$0 copay (Not applicable.) (Not applicable.)
Specialist$30 copay per visit (Authorization is required.) (Referral is not required.)

Preventive care

$0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$100 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$55 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures$0 copay (Authorization is required.) (Referral is not required.)
Lab services$0-50 copay (Authorization is required.) (Referral is not required.)
Diagnostic radiology services (e.g., MRI)$0-350 copay (Authorization is required.) (Referral is not required.)
Outpatient x-rays$0 copay (Authorization is required.) (Referral is not required.)

Hearing

Hearing exam$30 copay (Authorization is required.) (Referral is not required.)
Fitting/evaluation$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Hearing aids$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Preventive dental

Oral exam$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Cleaning$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Fluoride treatment$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Comprehensive dental

Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Diagnostic services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Vision

Routine eye exam$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Contact lenses$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Eyeglass frames$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Eyeglass lenses$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Upgrades$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Rehabilitation services

Occupational therapy visit$30 copay (Authorization is required.) (Referral is not required.)
Physical therapy and speech and language therapy visit$30 copay (Authorization is required.) (Referral is not required.)

Ground ambulance

$260 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

Foot exams and treatment$30 copay (Authorization is required.) (Referral is not required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is required.) (Not applicable.)
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
Diabetes supplies$0 copay per item (Authorization is required.) (Not applicable.)

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

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
Part B Insulin drugs$35 copay (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

$345 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)

Mental health services

Inpatient hospital – psychiatric$370 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
Outpatient group therapy visit with a psychiatrist$25 copay (Authorization is required.) (Referral is not required.)
Outpatient individual therapy visit with a psychiatrist$25 copay (Authorization is required.) (Referral is not required.)
Outpatient group therapy visit$25 copay (Authorization is required.) (Referral is not required.)
Outpatient individual therapy visit$25 copay (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

$0 per day for days 1 through 20
$203 per day for days 21 through 60
$0 per day for days 61 through 100 (Authorization is required.) (Referral is not required.)

Ready to sign up for Wellcare Patriot Giveback (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

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