5

5 out of 5 stars* for plan year 2024

Plan ID: H0111-002

What You Need to Know:

  • WellCare Prime (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $45, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $5,100 per year (in-network).
  • WellCare Prime (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $36.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$45

Monthly Premium

Medicare Plan Features
Monthly Premium: $45.00
Part C Premium: $9.20
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$45.00 $9.20 $35.80 $0 $35.80 $0 0.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H0111-003
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $5,100
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Jones, Georgia: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members 3 out of 5 Stars. 5 out of 5 Stars. 3 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,390 drugs
Number of Members Enrolled in this Plan in Jones, Georgia: 428 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$9.20 $35.80 $0.00 $45.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$15.20 $28.30 $37.50 $20.90 $30.10 $13.40 $22.60
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
546 $0.00 1539 $5.00 314 $45.00 319 45% 672 33%

Other Medicare Advantage Plans in Jones, Georgia

Plan Name Type Premium MOOP Rx Deduct. Rating
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
Anthem MediBlue Access Basic (PPO) (2023)Local PPO$6,700$150
4
HumanaChoice R3392-002 (Regional PPO) (2023)Regional PPO$6,700$340
4
UnitedHealthcare Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$6,700$295
5
Clear Spring Health Select (HMO) (2023)Local HMO$7,550$0
Insufficient data to rate this plan.
Anthem MediBlue Core (HMO) (2023)Local HMO *$7,550$-
5
UnitedHealthcare Medicare Advantage Patriot (Regional PPO (2023)Regional PPO *$6,700$-
5
Clear Spring Health Select Plus (HMO) (2023)Local HMO$7,550$0
Insufficient data to rate this plan.
Anthem MediBlue Plus (HMO) (2023)Local HMO$6,700$150
5
Clear Spring Health Choice Plan (PPO) (2023)Local PPO$7,550$250
Insufficient data to rate this plan.
HumanaChoice R3392-001 (Regional PPO) (2023)Regional PPO *$6,700$-
4
HumanaChoice H5525-024 (PPO) (2023)Local PPO$6,700$295
4
Anthem MediBlue Access (PPO) (2023)Local PPO$5,900$95
4
Anthem MediBlue Extra (HMO) (2023)Local HMO$5,900$445
5
HumanaChoice H5216-203 (PPO) (2023)Local PPO$7,550$0
4
Aetna Medicare Preferred Premium Plan (PPO) (2023)Local PPO$6,900$195
New plan - not yet rated.
Aetna Medicare Freedom Plan (PPO) (2023)Local PPO$6,900$200
New plan - not yet rated.
Clover Health Choice Value (PPO) (2023)Local PPO$7,550$445
4
Aetna Medicare Select Plan (HMO) (2023)Local HMO$6,900$250
5
WellCare Patriot (HMO-POS) (2023)Local HMO *$3,400$-
5
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
WellCare Premier (PPO) (2023)Local PPO$4,900$75
5
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
WellCare Dividend (HMO) (2023)Local HMO$6,700$200
5
Humana Gold Plus H4141-017 (HMO) (2023)Local HMO$7,550$0
4
WellCare Compass (HMO) (2023)Local HMO$3,450$445
5
HumanaChoice H5216-157 (PPO) (2023)Local PPO *$6,700$-
4
WellCare Endurance (PPO) (2023)Local PPO$4,900$0
5
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,900$-
New plan - not yet rated.
Clover Health Choice (PPO) (2023)Local PPO$7,550$0
4
WellCare Value (HMO) (2023)Local HMO$5,900$0
5
HumanaChoice H5216-154 (PPO) (2023)Local PPO$7,550$400
4
WellCare Flex Complete (PPO) (2023)Local PPO$2,500$0
5
Medicare Advantage Plans by WellCare
WellCare Patriot (HMO-POS) (2023)Local HMO *$3,400$-
5
WellCare Premier (PPO) (2023)Local PPO$4,900$75
5
WellCare Dividend (HMO) (2023)Local HMO$6,700$200
5
WellCare Compass (HMO) (2023)Local HMO$3,450$445
5
WellCare Endurance (PPO) (2023)Local PPO$4,900$0
5
WellCare Value (HMO) (2023)Local HMO$5,900$0
5
WellCare Flex Complete (PPO) (2023)Local PPO$2,500$0
5

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