Plan ID: H3047-001

What You Need to Know:

  • WellCare Premier (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 $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $75 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $5,000 per year (in-network).
  • WellCare Premier (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $75 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $0.

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$0 $0 $0 $0 $0 $75.00 1.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H3047-002
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): $5,000
Annual Deductible: $75 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in LaSalle, Louisiana: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members New plan - No summary rating as of yet. New plan - not yet rated. New plan - not yet rated.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,390 drugs
Number of Members Enrolled in this Plan in LaSalle, Louisiana: 105 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
$0.00 $0.00 $0.00 $0.00
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
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
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)
405 $0.00 433 $15.00 987 $47.00 893 $100.00 672 31%

Other Medicare Advantage Plans in LaSalle, Louisiana

Plan Name Type Premium MOOP Rx Deduct. Rating
Vantage STANDARD (HMO-POS) (2023)Local HMO$4,900$275
4
Blue Advantage (PPO) (2023)Local PPO$3,700$0
5
HumanaChoice H5216-202 (PPO) (2023)Local PPO$6,700$400
4
Blue Advantage (HMO) (2023)Local HMO$6,700$0
5
Vantage PREMIUM (HMO-POS) (2023)Local HMO$3,500$0
4
Wellcare Absolute (PPO) (2023)Local PPO$7,550$195
New plan - not yet rated.
Vantage BASIC (HMO-POS) (2023)Local HMO$5,900$445
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
HumanaChoice R0110-003 (Regional PPO) (2023)Regional PPO$7,550$400
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
HumanaChoice R0110-001 (Regional PPO) (2023)Regional PPO *$7,550$-
4
Vantage 100 (HMO-POS) (2023)Local HMO$-$0
4
Humana Gold Plus H1951-052 (HMO) (2023)Local HMO$7,550$0
4
Vantage TRADITIONAL PLUS (HMO-POS) (2023)Local HMO$7,550$445
4
WellCare Value (HMO) (2023)Local HMO$3,400$0
5
Humana Value Plus H5216-161 (PPO) (2023)Local PPO$7,550$425
4
WellCare Compass (HMO) (2023)Local HMO$3,400$445
5
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
WellCare Endurance (HMO) (2023)Local HMO$3,400$0
5
HumanaChoice H5216-064 (PPO) (2023)Local PPO$6,700$0
4
Medicare Advantage Plans by WellCare
Wellcare Absolute (PPO) (2023)Local PPO$7,550$195
New plan - not yet rated.
WellCare Value (HMO) (2023)Local HMO$3,400$0
5
WellCare Compass (HMO) (2023)Local HMO$3,400$445
5
WellCare Endurance (HMO) (2023)Local HMO$3,400$0
5

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