Wellcare Patriot No Premium Open (PPO)
H2775 - 108 - 0
(4 / 5)
Wellcare Patriot No Premium Open (PPO) is a Medicare Advantage Plan by Wellcare.
This page features plan details for 2022 Wellcare Patriot No Premium Open (PPO) H2775 – 108 – 0.
IMPORTANT: This page features the 2022 version of this plan. See the 2025 version using the link below:
No 2025 version found. You can use the location links below to find 2025 plans in your area.
Locations
Wellcare Patriot No Premium Open (PPO) is offered in the following locations.
Plan Overview
Wellcare Patriot No Premium Open (PPO) offers the following coverage and cost-sharing.
| Insurer: | Wellcare |
| Health Plan Deductible: | $0 |
| MOOP: | $6,700.00 |
| Drugs Covered: | No |
Ready to sign up for Wellcare Patriot No Premium Open (PPO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Premium Breakdown
Wellcare Patriot No Premium Open (PPO) 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 |
|---|---|---|---|
| $170.10 | $0.00 | $0.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Wellcare Patriot No Premium 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: 50% coinsurance (limits may apply) (authorization required) |
| Endodontics: | In-Network: $0 copay (limits may apply) (authorization required) |
| Endodontics: | Out-of-Network: 50% coinsurance (limits may apply) (authorization required) |
| Extractions: | In-Network: $0 copay (limits may apply) (authorization required) |
| Extractions: | Out-of-Network: 50% coinsurance (limits may apply) (authorization required) |
| Non-routine services: | In-Network: $0 copay (limits may apply) (authorization required) |
| Non-routine services: | Out-of-Network: 50% coinsurance (limits may apply) (authorization required) |
| Periodontics: | In-Network: $0 copay (limits may apply) (authorization required) |
| Periodontics: | Out-of-Network: 50% coinsurance (limits may apply) (authorization required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | In-Network: $0 copay (limits may apply) (authorization required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Out-of-Network: 50% coinsurance (limits may apply) (authorization required) |
| Restorative services: | In-Network: $0 copay (limits may apply) (authorization required) |
| Restorative services: | Out-of-Network: 50% coinsurance (limits may apply) (authorization required) |
Dental (preventive)
| Cleaning: | In-Network: $0 copay (limits may apply) (authorization required) |
| Cleaning: | Out-of-Network: 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: 50% coinsurance (limits may apply) (authorization required) |
| Fluoride treatment: | In-Network: $0 copay (limits may apply) (authorization required) |
| Fluoride treatment: | Out-of-Network: 50% coinsurance (limits may apply) (authorization required) |
| Oral exam: | In-Network: $0 copay (limits may apply) (authorization required) |
| Oral exam: | Out-of-Network: 50% coinsurance (limits may apply) (authorization required) |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | In-Network: $0-250 copay (authorization required) |
| Diagnostic radiology services (e.g., MRI): | Out-of-Network: 30% coinsurance (authorization required) |
| Diagnostic tests and procedures: | In-Network: $0 copay (authorization required) |
| Diagnostic tests and procedures: | Out-of-Network: 30% coinsurance (authorization required) |
| Lab services: | In-Network: $0 copay (authorization required) |
| Lab services: | Out-of-Network: 30% coinsurance (authorization required) |
| Outpatient x-rays: | In-Network: $0 copay (authorization required) |
| Outpatient x-rays: | Out-of-Network: 30% coinsurance (authorization required) |
Doctor visits
| Primary: | In-Network: $0 copay |
| Primary: | Out-of-Network: $15 copay per visit |
| Specialist: | In-Network: $30 copay per visit (authorization required) |
| Specialist: | Out-of-Network: $50 copay per visit (authorization required) |
Emergency care/Urgent care
| Emergency: | $90 copay per visit (always covered) |
| Urgent care: | $35 copay per visit (always covered) |
Foot care (podiatry services)
| Foot exams and treatment: | In-Network: $30 copay (authorization required) |
| Foot exams and treatment: | Out-of-Network: $50 copay (authorization required) |
| Routine foot care: | Not covered |
Ground ambulance
| In-Network: $325 copay | |
| Out-of-Network: $325 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: $30 copay (authorization required) |
| Hearing exam: | Out-of-Network: $50 copay (authorization required) |
Hospital coverage (inpatient)
| In-Network: $300 per day for days 1 through 6 $0 per day for days 7 through 90 (authorization required) | |
| Out-of-Network: $325 per day for days 1 through 7 $0 per day for days 8 and beyond (authorization required) |
Hospital coverage (outpatient)
| In-Network: $250 copay per visit (authorization required) | |
| Out-of-Network: 30% coinsurance per visit (authorization required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $6,700 In and Out-of-network $6,700 In-network |
Medical equipment/supplies
| Diabetes supplies: | In-Network: $0 copay per item (authorization required) |
| Diabetes supplies: | Out-of-Network: 20% 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: 20% 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: 20% coinsurance per item (authorization required) |
Medicare Part B drugs
| Chemotherapy: | In-Network: 20% coinsurance (authorization required) |
| Chemotherapy: | Out-of-Network: 30% coinsurance (authorization required) |
| Other Part B drugs: | In-Network: 20% coinsurance (authorization required) |
| Other Part B drugs: | Out-of-Network: 30% coinsurance (authorization required) |
Mental health services
| Inpatient hospital – psychiatric: | In-Network: $293 per day for days 1 through 6 $0 per day for days 7 through 90 (authorization required) |
| Inpatient hospital – psychiatric: | Out-of-Network: $314 per day for days 1 through 7 $0 per day for days 8 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: 30% coinsurance (authorization required) |
| Outpatient group therapy visit: | In-Network: $25 copay (authorization required) |
| Outpatient group therapy visit: | Out-of-Network: 30% 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: 30% coinsurance (authorization required) |
| Outpatient individual therapy visit: | In-Network: $25 copay (authorization required) |
| Outpatient individual therapy visit: | Out-of-Network: 30% 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: $35 copay (authorization required) |
| Occupational therapy visit: | Out-of-Network: 30% coinsurance (authorization required) |
| Physical therapy and speech and language therapy visit: | In-Network: $35 copay (authorization required) |
| Physical therapy and speech and language therapy visit: | Out-of-Network: 30% coinsurance (authorization required) |
Skilled Nursing Facility
| In-Network: $0 per day for days 1 through 20 $165 per day for days 21 through 100 (authorization required) | |
| Out-of-Network: $0 per day for days 1 through 20 $250 per day for days 21 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 Patriot No Premium Open (PPO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST