Over 28 million Americans rely on Medicare Advantage plans for their healthcare needs – but fewer than half understand how premium structures impact their coverage. This gap in knowledge could cost seniors thousands annually.
The H5199-008 plan, formally known as Wellcare No Premium Open (PPO), eliminates this confusion with a $0 monthly premium and comprehensive benefits. Designed for flexibility, it combines Medicare’s core offerings with added perks like prescription drug coverage and wellness programs.
Medicare Advantage plans like H5199-008 are reshaping how retirees manage healthcare costs. With no monthly fees, members gain access to hospital care, doctor visits, and preventive services. Many also receive dental, vision, or gym membership benefits at no extra cost.
Understanding plan specifications is critical when balancing coverage needs and budgets. This guide breaks down enrollment deadlines, network rules, and out-of-pocket limits. You’ll learn how to maximize benefits while avoiding surprise expenses.
Ready to explore how this health plan works in practice? The following sections provide a detailed analysis of costs, provider networks, and real-world scenarios where H5199-008 shines.
Key Takeaways
- The H5199-008 plan offers $0 monthly premiums for Medicare Advantage coverage
- Includes prescription drug benefits and preventive care services
- PPO structure allows flexibility in choosing healthcare providers
- Extra benefits often cover dental, vision, and fitness programs
- Understanding plan details prevents unexpected out-of-pocket costs
h5199-008 in Medicare Advantage: Plan Overview
The H5199-008 Medicare Advantage plan combines affordability with flexible care options. Designed as a Preferred Provider Organization (PPO), it allows members to visit both in-network and out-of-network providers without referrals. This structure balances cost control with healthcare access.
Key Features and Specifications
Wellcare’s $0 monthly premium for Parts C and D (excluding Part B) makes this plan financially accessible. Members pay no extra fees for core benefits like:
- Prescription drug coverage (Tier 1 generics often $0)
- Preventive care including annual checkups
- Emergency services worldwide
| Feature | Detail |
|---|---|
| Premium Cost | $0 for Parts C & D |
| Provider Network | 1.2 million+ nationwide providers |
| Drug Coverage | $445 annual deductible (2024) |
| Additional Benefits | Dental exams, fitness discounts |
Plan Eligibility and Coverage Areas
To enroll, you must have Medicare Parts A and B and live in the plan’s service area. Coverage spans 38 states, including Texas, Florida, and Illinois. Use Wellcare’s ZIP code lookup tool to confirm availability.
The plan operates under strict Medicare Advantage guidelines, requiring annual renewals during Open Enrollment (Oct 15-Dec 7). Out-of-pocket maximums protect against catastrophic costs – $8,300 for in-network care in 2024.
Detailed Cost and Coverage Breakdown
Breaking down costs reveals the true value of Medicare Advantage plans. The H5199-008 plan combines $0 monthly premiums with predictable out-of-pocket limits, making healthcare budgeting simpler for retirees.
Premiums, Deductibles, and Out-of-Pocket Costs
Members pay $0 for the health plan premium, though Medicare Part B premiums still apply ($174.70/month standard rate). The annual drug deductible sits at $450, with tiered copays starting at $0 for generic medications. In-network care carries a $5,500 maximum out-of-pocket limit, while out-of-network services cap at $8,950.
Hospital stays illustrate cost-sharing details. For the first 5 days, you’ll pay $395 per admission. Outpatient surgeries have a 20% coinsurance rate after meeting your deductible.
Drug Coverage and Part D Details
The plan uses a 5-tier formulary system. Tier 1 generics often cost $0, while specialty drugs (Tier 5) require 33% coinsurance. During the initial coverage phase, you’ll pay set copays until reaching $4,660 in total drug costs.
Once past this limit, gap coverage reduces brand-name drug costs by 75%. Preferred network pharmacies offer lower prices, with mail-order options for 90-day supplies. Always check the plan’s formulary before filling prescriptions to avoid surprise expenses.
Exploring Additional Plan Benefits and Services
Beyond standard medical coverage, the H5199-008 plan delivers value through specialized support programs. Members gain access to preventive care tools and financial safeguards that address modern healthcare challenges.
Diagnostic, Hospital, and Specialist Services Overview
Preventive care starts with $0 copays for diagnostic tests like bloodwork and X-rays. Advanced imaging services (MRIs/CT scans) cost $75-$150 when using in-network providers. Out-of-network facilities may charge 40% coinsurance.
Hospital stays follow clear cost rules. Members pay $395 per admission for the first 5 days. Specialist visits require a $45 copay within the network, compared to $90 for out-of-network consultations. Emergency care remains covered at $110 per visit nationwide.
The plan enhances traditional Medicare with telehealth options – virtual doctor visits cost $10 through Wellcare’s platform. Wellness programs include free gym memberships and nutrition counseling. Those qualifying for Extra Help subsidies see reduced drug costs, with some generics dropping to $0.
| Service | In-Network Cost | Out-of-Network |
|---|---|---|
| Lab Tests | $0 | 20% coinsurance |
| Specialist Visit | $45 | $90 |
| MRI Scan | $150 | $600+ |
For prescription support, review 2024 Medicare Advantage plans with drug coverage to compare formularies. The H5199-008 plan bridges coverage gaps with $3,100 in annual drug cost protection before catastrophic coverage begins.
Conclusion
Choosing the right Medicare Advantage plan requires balancing cost controls with comprehensive coverage. The H5199-008 option stands out with its $0 monthly premium and PPO flexibility, providing access to over 1.2 million providers nationwide. Members benefit from predictable costs, including a $445 prescription deductible and $8,300 annual out-of-pocket limit for in-network care.
This plan’s five-tier drug formulary offers $0 copays for generics during the initial coverage phase, while Extra Help subsidies reduce costs for eligible beneficiaries. Added benefits like dental exams and fitness programs address holistic health needs without premium increases.
Before enrolling, verify your eligibility through Medicare’s online tools or consult a licensed agent to review coverage details. Understanding formulary tiers, network rules, and gap coverage protections ensures informed decisions about healthcare budgeting.
With its blend of core Medicare protections and supplemental advantages, this approach demonstrates how strategic plan selection can optimize both financial security and care access.
FAQ
What is the H5199-008 Medicare Advantage plan?
Which areas does the H5199-008 plan cover?
Are all prescription drugs covered under this plan?
What are the premiums and deductibles for this plan?
FAQ
What is the H5199-008 Medicare Advantage plan?
The H5199-008 Medicare Advantage plan combines Medicare Parts A and B with additional benefits like prescription drug coverage (Part D). It often includes extras such as dental, vision, or wellness programs, depending on your location and plan type.
Which areas does the H5199-008 plan cover?
Coverage areas vary by ZIP code. Most Medicare Advantage plans, including H5199-008, operate within specific service regions. Check with providers like Wellcare Premium Open or local PPO networks to confirm availability in your area.
Are all prescription drugs covered under this plan?
Drugs are covered based on the plan’s formulary, which categorizes medications into tiers. Generic drugs usually have lower copays, while specialty drugs may cost more. Prior authorization or step therapy might apply for certain medications.
What are the premiums and deductibles for this plan?
Monthly premiums vary, but some plans start at
FAQ
What is the H5199-008 Medicare Advantage plan?
The H5199-008 Medicare Advantage plan combines Medicare Parts A and B with additional benefits like prescription drug coverage (Part D). It often includes extras such as dental, vision, or wellness programs, depending on your location and plan type.
Which areas does the H5199-008 plan cover?
Coverage areas vary by ZIP code. Most Medicare Advantage plans, including H5199-008, operate within specific service regions. Check with providers like Wellcare Premium Open or local PPO networks to confirm availability in your area.
Are all prescription drugs covered under this plan?
Drugs are covered based on the plan’s formulary, which categorizes medications into tiers. Generic drugs usually have lower copays, while specialty drugs may cost more. Prior authorization or step therapy might apply for certain medications.
What are the premiums and deductibles for this plan?
Monthly premiums vary, but some plans start at $0. The annual deductible and out-of-pocket costs depend on factors like your healthcare usage and whether you qualify for Extra Help subsidies. Check the plan’s Summary of Benefits for exact figures.
Does H5199-008 include gap coverage for prescriptions?
Yes, most Medicare Advantage plans with Part D offer some coverage during the donut hole (coverage gap). You’ll pay a percentage of drug costs until reaching catastrophic coverage. The plan may also provide discounts on generics during this phase.
Can I keep my doctor with this Medicare Advantage plan?
This depends on whether your doctor is in the plan’s network. HMO plans require in-network providers, while PPO options like Wellcare Premium Open allow out-of-network care at higher costs. Always verify provider participation before enrolling.
Are there income-based subsidies for this plan?
Yes, if you qualify for Extra Help (Low-Income Subsidy), your Part D premiums, deductibles, and copays may be reduced. Income and resource limits apply. Contact Social Security or your state Medicaid office to check eligibility.
What hospital services are covered under H5199-008?
The plan covers inpatient hospital stays, including surgery and skilled nursing care, under Part A. Copays or coinsurance may apply after meeting your deductible. Some plans also offer post-discharge meal delivery or home health visits.
How does the formulary affect my drug costs?
Formularies list covered drugs and their tiers. Tier 1 (generics) has the lowest costs, while Tier 4 (specialty drugs) may require higher copays. Review the formulary annually, as changes can affect your out-of-pocket expenses.
What is the maximum out-of-pocket limit for this plan?
Medicare Advantage plans cap annual out-of-pocket costs for Part A/B services. In 2024, the federal limit is $8,850, but some plans set lower limits. This cap does not apply to Part D prescription drug costs.
. The annual deductible and out-of-pocket costs depend on factors like your healthcare usage and whether you qualify for Extra Help subsidies. Check the plan’s Summary of Benefits for exact figures.
Does H5199-008 include gap coverage for prescriptions?
Yes, most Medicare Advantage plans with Part D offer some coverage during the donut hole (coverage gap). You’ll pay a percentage of drug costs until reaching catastrophic coverage. The plan may also provide discounts on generics during this phase.
Can I keep my doctor with this Medicare Advantage plan?
This depends on whether your doctor is in the plan’s network. HMO plans require in-network providers, while PPO options like Wellcare Premium Open allow out-of-network care at higher costs. Always verify provider participation before enrolling.
Are there income-based subsidies for this plan?
Yes, if you qualify for Extra Help (Low-Income Subsidy), your Part D premiums, deductibles, and copays may be reduced. Income and resource limits apply. Contact Social Security or your state Medicaid office to check eligibility.
What hospital services are covered under H5199-008?
The plan covers inpatient hospital stays, including surgery and skilled nursing care, under Part A. Copays or coinsurance may apply after meeting your deductible. Some plans also offer post-discharge meal delivery or home health visits.
How does the formulary affect my drug costs?
Formularies list covered drugs and their tiers. Tier 1 (generics) has the lowest costs, while Tier 4 (specialty drugs) may require higher copays. Review the formulary annually, as changes can affect your out-of-pocket expenses.
What is the maximum out-of-pocket limit for this plan?
Medicare Advantage plans cap annual out-of-pocket costs for Part A/B services. In 2024, the federal limit is ,850, but some plans set lower limits. This cap does not apply to Part D prescription drug costs.