Plan ID: H0969-001

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 $160 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $6,700 per year (in-network).
  • WellCare Premier (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $160 (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 $160.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H0969-002
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $6,700
Annual Deductible: $160 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Grafton, New Hampshire: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
72 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 Grafton, New Hampshire: 1,233 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 $12.00 987 $47.00 893 48% 672 30%

Other Medicare Advantage Plans in Grafton, New Hampshire

Plan Name Type Premium MOOP Rx Deduct. Rating
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$6,700$-
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Anthem MediBlue Coordination Plus (HMO) (2023)Local HMO$7,550$445
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HumanaChoice H5216-057 (PPO) (2023)Local PPO$5,400$0
4
HumanaChoice H5216-058 (PPO) (2023)Local PPO$6,700$300
4
Humana Honor (PPO) (2023)Local PPO *$4,500$-
4
HumanaChoice H5216-138 (PPO) (2023)Local PPO$7,550$295
4
Martin's Point Generations Advantage Prime (HMO-POS) (2023)Local HMO$6,850$0
5
Martin's Point Generations Advantage Alliance (HMO) (2023)Local HMO *$5,000$-
5
Humana Value Plus H5619-065 (HMO) (2023)Local HMO$7,550$445
4
Humana Gold Plus H5619-137 (HMO) (2023)Local HMO$6,700$400
4
UnitedHealthcare Medicare Advantage Assure (PPO) (2023)Local PPO$7,550$445
5
Aetna Medicare Elite Plan (HMO) (2023)Local HMO$7,550$0
5
WellCare Prime (PPO) (2023)Local PPO$6,000$0
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Harvard Pilgrim Stride Basic Rx (HMO) (2023)Local HMO$6,700$445
3
Martin's Point Generations Advantage Select (PPO) (2023)Local PPO$7,300$0
5
Harvard Pilgrim Stride Value Rx Plus (HMO) (2023)Local HMO$5,000$270
3
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Harvard Pilgrim Stride Value Rx (HMO) (2023)Local HMO$5,600$270
3
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Harvard Pilgrim Stride Choice Rx (HMO-POS) (2023)Local HMO$5,600$270
3
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$6,700$350
5
Anthem MediBlue Access (PPO) (2023)Local PPO$6,700$260
4
Aetna Medicare Explorer Plan (PPO) (2023)Local PPO$7,550$0
5
AARP Medicare Advantage Plan 4 (HMO) (2023)Local HMO$6,700$0
5
WellCare Value (HMO) (2023)Local HMO$7,550$160
New plan - not yet rated.
Martin's Point Generations Advantage Flex (Regional PPO) (2023)Regional PPO$5,500$275
5
WellCare Plus (HMO) (2023)Local HMO$3,450$445
New plan - not yet rated.
AARP Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$7,550$295
5
AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$6,700$195
New plan - not yet rated.
Medicare Advantage Plans by WellCare
WellCare Prime (PPO) (2023)Local PPO$6,000$0
New plan - not yet rated.
WellCare Value (HMO) (2023)Local HMO$7,550$160
New plan - not yet rated.
WellCare Plus (HMO) (2023)Local HMO$3,450$445
New plan - not yet rated.

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