Plan ID: H5199-013

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 $90, 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 $1,700 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 $27.

$90

Monthly Premium

Medicare Plan Features
Monthly Premium: $90.00
Part C Premium: $63.30
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$90.00 $63.30 $26.70 $0 $26.70 $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: H5199-014
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): $1,700
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Duval, Florida: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
13 members New plan - No summary rating as of yet. New plan - not yet rated. 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 Duval, Florida: NULL
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
$63.30 $26.70 $0.00 $90.00
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
$63.30 $20.00 $83.30 $13.30 $76.60 $6.70 $70.00
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)
546 $0.00 1539 $5.00 314 $47.00 319 $100.00 672 33%

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HumanaChoice Florida H5216-070 (PPO) (2023)Local PPO$5,500$175
4
Humana Gold Plus H1036-081D (HMO) (2023)Local HMO$3,400$0
4
CareOne (HMO) (2023)Local HMO$3,400$0
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CareFree (HMO) (2023)Local HMO$3,900$100
5
AARP Medicare Advantage Choice Plan 2 (Regional PPO) (2023)Regional PPO$6,700$395
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CareOne PLATINUM (HMO) (2023)Local HMO$4,000$0
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Humana Gold Plus H1036-270 (HMO) (2023)Local HMO$4,500$0
4
HumanaChoice R5826-074 (Regional PPO) (2023)Regional PPO$7,550$395
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$5,900$175
5
HumanaChoice Florida H7284-006 (PPO) (2023)Local PPO$3,900$445
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AARP Medicare Advantage (HMO-POS) (2023)Local HMO$3,700$0
5
BlueMedicare Value (PPO) (2023)Local PPO$4,500$150
4
Aetna Medicare Premier (PPO) (2023)Local PPO$6,700$300
5
AARP Medicare Advantage Patriot (Regional PPO) (2023)Regional PPO *$6,700$-
5
HumanaChoice R5826-005 (Regional PPO) (2023)Regional PPO$6,700$100
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
WellCare Dividend Prime (HMO) (2023)Local HMO$3,200$0
4
WellCare Elite (HMO) (2023)Local HMO$2,500$0
4
WellCare Premier (PPO) (2023)Local PPO$4,500$150
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Devoted Health Prime Greater Jacksonville (HMO) (2023)Local HMO$3,400$0
4
Aetna Medicare Premier Plus (PPO) (2023)Local PPO$5,900$150
5
HumanaChoice R5826-018 (Regional PPO) (2023)Regional PPO *$7,550$-
4
BlueMedicare Classic (HMO) (2023)Local HMO$4,900$0
4
BlueMedicare Select (PPO) (2023)Local PPO$5,900$305
4
BlueMedicare Choice (Regional PPO) (2023)Regional PPO$6,500$250
4
Devoted Health Core Greater Jacksonville (HMO) (2023)Local HMO$3,400$0
4
Devoted Health Essentials Greater Jacksonville (HMO) (2023)Local HMO$3,400$0
4
Aetna Medicare Select (HMO) (2023)Local HMO$3,450$0
5
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
BlueMedicare Premier (HMO) (2023)Local HMO$3,000$0
4
Medicare Advantage Plans by WellCare
WellCare Dividend Prime (HMO) (2023)Local HMO$3,200$0
4
WellCare Elite (HMO) (2023)Local HMO$2,500$0
4
WellCare Premier (PPO) (2023)Local PPO$4,500$150
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