ᎭᏓᎾᏫᏓ ᎾᎢ ᏄᎬᏫᏳᏒ ᎦᎸᏛᎢ

Medicare is a federal health insurance program. It is available to people 65 and older, people under 65 with certain disabilities and people with end-stage renal disease. When you are ready to decide on a plan, take the time to understand how the plans work. That way, you can make an informed decision and choose the plan that is right for you.

When It Comes to Coverage, You Have Options

You have the choice of your Medicare coverage. There are two primary options, Original Medicare and Medicare Advantage (also known as Part C).

What are the parts of Medicare?

Original Medicare is a fee-for-service health plan managed by the federal government that has two parts: Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). For drug coverage, you can join a separate Medicare drug plan (Part D).

Learn more about the individual parts of Medicare:

Part A - Hospital Coverage

Helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care

Part B - Medical Coverage

Helps cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds and other equipment)
  • Many preventive services (like screenings, shots/vaccines and yearly "Wellness" visits)

Medicare Advantage (also known as Part C)

  • An "all in one" alternative to Original Medicare that includes Part A, Part B and, usually, Part D.
  • Plans may have lower out-of-pocket costs than Original Medicare.
  • Most plans offer extra benefits that Original Medicare doesn't cover such as vision, hearing, dental and more.

Part D - Prescription Drug Coverage

Helps cover:

  • Cost of prescription drugs (including many recommended shots and vaccines)

Part D plans are run by private insurance companies that follow rules set by Medicare.

What are Medicare Advantage plans?

A Medicare Advantage Plan is another way to get your Medicare Part A (hospital insurance) and Part B (Medicare insurance) coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies that are approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A and Part B coverage, excluding hospice care. Most plans also include drug coverage (Part D). Medicare Advantage plans often offer coverage for things Original Medicare doesn't cover, such as vision, hearing, dental, and fitness programs (like gym memberships or discounts).

There are different types of Medicare Advantage plans. The most common types of plans include:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)

ᎤᎵᏍᎨᏓ ᎧᏃᎮᏢᎥᏍᎩ

ᎤᏓᏤᏟᏓ ᏚᏚᎸᏛᎢ

Wellcare Special Needs Plans (SNPs) are tailored to meet the needs of people who are:

  • Eligible for Medicare
  • Living on a limited income
  • Eligible for Medicaid

If you qualify for a SNP, your plan may include:

  • Hospital, doctor and prescription drug coverage
  • Care management services
  • Routine vision and dental coverage
  • Help to pay for things like vitamins, first aid supplies and dental products
  • Help to and from your medical appointments

Wellcare may have a SNP that meets your needs. This depends on your level of Medicaid. Contact Us to learn more about SNPs.

Disclaimers

Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc.

Texas Residents: Wellcare (HMO and HMO SNP) includes products that are underwritten by WellCare of Texas, Inc., WellCare National Health Insurance Company, and SelectCare of Texas, Inc.

Washington residents: “Wellcare" is issued by WellCare Health Insurance Company of Washington, Inc.

Wellcare Dual Liberty (HMO D-SNP) Members: Wellcare Dual Liberty (HMO D-SNP) is a Fully Integrated Dual Eligible Special Needs Plan with a Medicare contract and a contract with the New Jersey Medicaid program. Enrollment in Wellcare Dual Liberty depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations and restrictions may apply. Benefits may change on January 1 of each year. Your Part B premium is covered by Medicaid. This plan is available to those who have both Medicare and full Medicaid benefits. Wellcare uses a formulary. Please contact Wellcare for details.

Every year, Medicare evaluates plans based on a 5-star rating system.

Louisiana D-SNP members: As a WellCare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through WellCare and are also eligible to receive additional health care services and coverage through Louisiana Medicaid. Learn more about providers who participate in Louisiana Medicaid by visiting myplan.healthy.la.gov/en/find-provider. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at ldh.la.gov/medicaid and select the “Learn about Medicaid Services” link.

Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at ldh.la.gov/medicaid.

Notice: TennCare is not responsible for payment for these benefits, except for appropriate cost sharing amounts. TennCare is not responsible for guaranteeing the availability or quality of these benefits. Any benefits above and beyond traditional Medicare benefits are applicable to Wellcare Medicare Advantage only and do not indicate increased Medicaid benefits.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Wellcare’s pharmacy network includes limited lower-cost preferred pharmacies in rural areas of MO and NE. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-833-444-9088 (TTY 711) for Wellcare No Premium (HMO) and Wellcare Giveback (HMO) in MO or consult the online pharmacy directory at wellcare.com/medicare; and 1-833-542-0693 (TTY 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), and Wellcare No Premium Open (PPO) in NE or consult the online pharmacy directory at wellcare.com/NE.

Value-Added Items and Services (VAIS) are not plan benefits and are not covered by the plan. Plan enrollees are responsible for all costs.

Please contact your plan for details.

ᏗᏓᏚᎯᏍᏙᏗ

ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏱᏣᏛᏁᏗᏱ ᏫᏍᏝᏗ ᎾᎢ ᎠᏓᏚᎯᏍᏙᏗ ᎠᎴ ᎠᏓᏁᎳᏁᏗ ᎦᏬᎯᎵᏴᏓ ᏂᎦᏯᎢᏒᏊ ᎾᎾᎢ Medicare ᏄᏰᎵᏛ ᎣᎦᏤᎵ ᎠᏍᏓᏩᏛᏍᏗ. ᎠᏍᏆᏛᎢ ᎠᎴ ᏫᎦᏅᏗ ᎾᏍᎩᎾ Medicare ᎦᏬᎯᎵᏴᏓ ᎠᎴ ᎠᎵᏍᎦᏃᏍᏗ ᎠᎧᎵᎢᏍᏗ.

Medicare ᎾᏍᎩ ᎤᏂᎭ ᏗᎦᎸᏫᏍᏓᏁᏗ ᎾᎿᎢ ᎾᏍᎩ Medicare ᎣᏥᎸᏍᎦᏯ (OMO) ᎾᏍᎩᎾᎢ ᏰᎵᏊ ᏱᏍᏕᎵ ᎤᏠᏯᏍᏗ ᎠᎵᏍᎦᏃᏍᏗ, ᏗᏓᏚᎯᏍᏙᏗ ᎠᎴ ᎧᏃᎮᏢᎥᏍᎩᏗᏔᏲᏍᏗ. ᎠᏩᏛᎯᏓᏍᏗ Medicare.gov ᎾᏍᎩᎾ ᎤᏟ ᎢᎦᎢ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ Medicare ᎠᎴ/ᎠᎴᏃ ᎠᏓᏍᏕᎵᏍᎩ ᎬᏗ ᏗᎵᏍᎦᏃᏍᏗ ᎠᎴ ᏗᏓᏚᎯᏍᏙᏗ.

How to access coverage in the event of a disaster or local emergency.

In the event of an emergency or natural disaster, Wellcare is committed to helping you continue to access care easily. In a time of crisis, we will:

  • Allow Part A and Part B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities (note that Part A and Part B benefits must, per 42 CFR §422.204(b)(3), be furnished at Medicare certified facilities)
  • Waive in full, requirements for gatekeeper referrals where applicable
  • Temporarily reduce plan-approved out-of-network cost-sharing to in-network cost sharing amounts
  • Waive the 30-day notification requirement to enrollees as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the enrollee
  • Allow you to fill medications sooner than usual to ensure you have what you need during the emergency 

These actions will be in effect through the emergency declaration period. Disasters/Emergencies may be declared by the U.S. Government, the Federal Emergency Management Agency (FEMA), or the Governor of any state.

Typically, the source which declares the disaster will clarify when the disaster or emergency is over. If however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if the Centers for Medicare & Medicaid Services (CMS) has not indicated an end date to the disaster or emergency, we will resume normal operations 30 days from the initial declaration.

  • Special Needs

    ᎤᏓᏤᏟᏓ ᏚᏚᎸᏛᎢ

    Wellcare Special Needs Plans (SNPs) are tailored to meet the needs of people who are:

    • Eligible for Medicare
    • Living on a limited income
    • Eligible for Medicaid

    If you qualify for a SNP, your plan may include:

    • Hospital, doctor and prescription drug coverage
    • Care management services
    • Routine vision and dental coverage
    • Help to pay for things like vitamins, first aid supplies and dental products
    • Help to and from your medical appointments

    Wellcare may have a SNP that meets your needs. This depends on your level of Medicaid. Contact Us to learn more about SNPs.

  • ᏗᎦᎾᏄᎪᏫᏍᏗ

    Disclaimers

    Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

    ‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc.

    Texas Residents: Wellcare (HMO and HMO SNP) includes products that are underwritten by WellCare of Texas, Inc., WellCare National Health Insurance Company, and SelectCare of Texas, Inc.

    Washington residents: “Wellcare" is issued by WellCare Health Insurance Company of Washington, Inc.

    Wellcare Dual Liberty (HMO D-SNP) Members: Wellcare Dual Liberty (HMO D-SNP) is a Fully Integrated Dual Eligible Special Needs Plan with a Medicare contract and a contract with the New Jersey Medicaid program. Enrollment in Wellcare Dual Liberty depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations and restrictions may apply. Benefits may change on January 1 of each year. Your Part B premium is covered by Medicaid. This plan is available to those who have both Medicare and full Medicaid benefits. Wellcare uses a formulary. Please contact Wellcare for details.

    Every year, Medicare evaluates plans based on a 5-star rating system.

    Louisiana D-SNP members: As a WellCare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through WellCare and are also eligible to receive additional health care services and coverage through Louisiana Medicaid. Learn more about providers who participate in Louisiana Medicaid by visiting myplan.healthy.la.gov/en/find-provider. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at ldh.la.gov/medicaid and select the “Learn about Medicaid Services” link.

    Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at ldh.la.gov/medicaid.

    Notice: TennCare is not responsible for payment for these benefits, except for appropriate cost sharing amounts. TennCare is not responsible for guaranteeing the availability or quality of these benefits. Any benefits above and beyond traditional Medicare benefits are applicable to Wellcare Medicare Advantage only and do not indicate increased Medicaid benefits.

    Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

    Wellcare’s pharmacy network includes limited lower-cost preferred pharmacies in rural areas of MO and NE. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-833-444-9088 (TTY 711) for Wellcare No Premium (HMO) and Wellcare Giveback (HMO) in MO or consult the online pharmacy directory at wellcare.com/medicare; and 1-833-542-0693 (TTY 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), and Wellcare No Premium Open (PPO) in NE or consult the online pharmacy directory at wellcare.com/NE.

    Value-Added Items and Services (VAIS) are not plan benefits and are not covered by the plan. Plan enrollees are responsible for all costs.

    Please contact your plan for details.

  • ᏗᏓᏚᎯᏍᏙᏗ

    ᏗᏓᏚᎯᏍᏙᏗ

    ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏱᏣᏛᏁᏗᏱ ᏫᏍᏝᏗ ᎾᎢ ᎠᏓᏚᎯᏍᏙᏗ ᎠᎴ ᎠᏓᏁᎳᏁᏗ ᎦᏬᎯᎵᏴᏓ ᏂᎦᏯᎢᏒᏊ ᎾᎾᎢ Medicare ᏄᏰᎵᏛ ᎣᎦᏤᎵ ᎠᏍᏓᏩᏛᏍᏗ. ᎠᏍᏆᏛᎢ ᎠᎴ ᏫᎦᏅᏗ ᎾᏍᎩᎾ Medicare ᎦᏬᎯᎵᏴᏓ ᎠᎴ ᎠᎵᏍᎦᏃᏍᏗ ᎠᎧᎵᎢᏍᏗ.

    Medicare ᎾᏍᎩ ᎤᏂᎭ ᏗᎦᎸᏫᏍᏓᏁᏗ ᎾᎿᎢ ᎾᏍᎩ Medicare ᎣᏥᎸᏍᎦᏯ (OMO) ᎾᏍᎩᎾᎢ ᏰᎵᏊ ᏱᏍᏕᎵ ᎤᏠᏯᏍᏗ ᎠᎵᏍᎦᏃᏍᏗ, ᏗᏓᏚᎯᏍᏙᏗ ᎠᎴ ᎧᏃᎮᏢᎥᏍᎩᏗᏔᏲᏍᏗ. ᎠᏩᏛᎯᏓᏍᏗ Medicare.gov ᎾᏍᎩᎾ ᎤᏟ ᎢᎦᎢ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ Medicare ᎠᎴ/ᎠᎴᏃ ᎠᏓᏍᏕᎵᏍᎩ ᎬᏗ ᏗᎵᏍᎦᏃᏍᏗ ᎠᎴ ᏗᏓᏚᎯᏍᏙᏗ.

  • How to access coverage in the event of a disaster or local emergency

    How to access coverage in the event of a disaster or local emergency.

    In the event of an emergency or natural disaster, Wellcare is committed to helping you continue to access care easily. In a time of crisis, we will:

    • Allow Part A and Part B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities (note that Part A and Part B benefits must, per 42 CFR §422.204(b)(3), be furnished at Medicare certified facilities)
    • Waive in full, requirements for gatekeeper referrals where applicable
    • Temporarily reduce plan-approved out-of-network cost-sharing to in-network cost sharing amounts
    • Waive the 30-day notification requirement to enrollees as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the enrollee
    • Allow you to fill medications sooner than usual to ensure you have what you need during the emergency 

    These actions will be in effect through the emergency declaration period. Disasters/Emergencies may be declared by the U.S. Government, the Federal Emergency Management Agency (FEMA), or the Governor of any state.

    Typically, the source which declares the disaster will clarify when the disaster or emergency is over. If however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if the Centers for Medicare & Medicaid Services (CMS) has not indicated an end date to the disaster or emergency, we will resume normal operations 30 days from the initial declaration.

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ᎤᏚᎸᏓ ᎠᏍᏕᎸᏗᎢ? ᎠᎭᏂ ᎣᏤᏙ ᏂᎯ ᏳᏰᎵᏗ.

ᎢᏍᎩᏟᏃᎮᏓ ᏂᎦᏓ
Y0020_WCM_87476E Last Updated On: 10/6/2022