2.5 out of 5 stars* for plan year 2024
$0.00 Monthly Premium
Wellcare Giveback Open (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by WellCare Health Plans, Inc.
Plan ID: H6713-002-000
$0.00 Monthly Premium
Illinois Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.
Learn more about Illinois Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
Basic Costs and Coverage
Coverage | Details |
---|---|
Monthly plan premium | $0.00 |
Vision coverage | |
Dental coverage | |
Hearing coverage | |
Prescription drugs | |
Medical deductible | $545.00 |
Out-of-pocket maximum | $5,000.00 |
Initial drug coverage limit | $0.00 |
Catastrophic drug coverage limit | $8,000.00 |
Primary care doctor visit | Out-of-Network: Doctor Office Visit: |
Specialty doctor visit | Out-of-Network: Doctor Specialty Visit: |
Inpatient hospital care | In-Network: Acute Hospital Services: |
Urgent care | Urgent Care: Copayment for Urgent Care $0.00 Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours Worldwide Coverage: |
Emergency room visit | Emergency Care: Copayment for Emergency Care $120.00 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours Worldwide Coverage: |
Ambulance transportation | In-Network: Ground Ambulance: Air Ambulance: Please see Evidence of Coverage for Prior Authorization rules |
Health Care Services and Medical Supplies
Wellcare Giveback Open (PPO) covers a range of additional benefits. Learn more about Wellcare Giveback Open (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
Coverage | Details |
---|---|
Chiropractic services | In-Network: Chiropractic Services: |
Diabetes supplies, training, nutrition therapy and monitoring | In-Network: Diabetic Supplies and Services: |
Durable medical equipment (DME) | Out-of-Network: Durable Medical Equipment: |
Diagnostic tests, lab and radiology services, and X-rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Outpatient Diag/Therapeutic Rad Services: |
Home health care | In-Network: Home Health Services: |
Mental health inpatient care | Out-of-Network: 20% per day for days 1 to 90 |
Mental health outpatient care | In-Network: Outpatient Mental Health Services: |
Outpatient services/surgery | In-Network: Outpatient Hospital Services: Outpatient Observation Services: Ambulatory Surgical Center Services: |
Outpatient substance abuse care | In-Network: Outpatient Substance Abuse Services: |
Podiatry services | Out-of-Network: Podiatry Services: |
Skilled Nursing Facility (SNF) care | In-Network: Skilled Nursing Facility Services: |
Dental Benefits
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Coverage | Details |
---|---|
Dental care | Out-of-Network: Medicare Covered Dental Services: |
Vision Benefits
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Coverage | Details |
---|---|
Vision benefits | Out-of-Network: Medicare Covered Vision Services: |
Hearing Benefits
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Coverage | Details |
---|---|
Hearing benefits | Out-of-Network: Medicare Covered Hearing Services: |
Preventive Services and Health/Wellness Education Programs
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Coverage | Details |
---|---|
Preventive services and health/wellness education programs | In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening
Yearly "Wellness" visit |
Prescription Drug Costs and Coverage
The Wellcare Giveback Open (PPO) offers prescription drug coverage, with an annual drug deductible of $545.00 (excludes Tiers 1, 2 and 6)
Coverage | Cost |
---|---|
Coverage & Cost | |
Annual drug deductible | $545.00 (excludes Tiers 1, 2 and 6) |
Tier 1 | |
Tier 2 | |
Tier 6 | |
Annual drug deductible | $545.00 (excludes Tiers 1, 2 and 6) |
Tier 1 | |
Tier 2 | |
Tier 6 | |
Annual drug deductible | $545.00 (excludes Tiers 1, 2 and 6) |
Tier 1 | |
Tier 2 | |
Tier 6 |
When reviewing Illinois Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of Illinois that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
Links to plan documents |
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Illinois Counties Served
Adams Bond Boone Brown Bureau Calhoun Carroll Cass Champaign Christian Clark Clay Clinton Coles Cook Crawford Cumberland Dekalb Dewitt Douglas Dupage Edgar Edwards Effingham Fayette Ford Franklin Fulton Gallatin Greene Grundy Hamilton Hanco*ck Hardin Henderson Henry Iroquois Jackson Jasper Jefferson Jersey Johnson Kane Kankakee Kendall Knox La Salle Lee Livingston Logan Macon Macoupin Madison Marion Marshall Mason Mcdonough Mchenry Mclean Menard Mercer Monroe Montgomery Morgan Moultrie Ogle Peoria Perry Piatt Pike Pope Pulaski Putnam Richland Rock Island Saint Clair Saline Sangamon Schuyler Scott Shelby Stark Stephenson Tazewell Union Vermilion Warren Washington Wayne White Whiteside Will Winnebago Woodford
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
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