Medicare Basics

Mga Disclaimer

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

Ang Wellcare ang brand ng Medicare para sa Centene Corporation, isang HMO, PPO, PFFS, PDP na plano na may kontrata sa Medicare at isang aprubadong Sponsor ng Part D. Ang aming mga D-SNP na plano ay may kontrata sa programang Medicaid sa estado. Ang pagpapatala sa aming mga plano ay nakadepende sa pag-renew ng kontrata.

Washington residents: “Wellcare” is issued by Coordinated Care of Washington, Inc., a subsidiary of Centene Corporation.

Washington residents: “Wellcare” is issued by WellCare Health Insurance Company of Washington, Inc., a subsidiary of Centene Corporation.

Bawat taon, sinusuri ng Medicare ang mga plano batay sa 5-star na sistema sa pag-rate.

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. 

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

Paunawa: Hindi pananagutan ng TennCare ang pagbabayad para sa mga benepisyong ito, maliban para sa mga naaangkop na halaga ng bahagi sa gastos. Hindi pananagutan ng TennCare ang paggarantiya sa pagiging available o sa kalidad ng mga benepisyong ito. Ang anumang benepisyong hindi kasama sa mga karaniwang benepisyo ng Medicare ay nalalapat lang sa Wellcare Medicare Advantage at hindi ito nagsasaad ng mas pinaraming benepisyo sa Medicaid.

Texas 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 Texas Medicaid. Learn more about providers who participate in Texas Medicaid by visiting www.wellcarefindaprovider.com/navigate-a-network.html. For detailed information about Texas Medicaid benefits, please visit the Texas Medicaid website at www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. To request a written copy of our Medicaid Provider Directory, please

Texas D-SNP prospective enrollees: For detailed information about Texas Medicaid benefits, please visit the Texas Medicaid website at www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. To request a written copy of our Medicaid Provider Directory, please contact us.

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 www.myplan.healthy.la.gov/en/find-provider or www.louisianahealthconnect.com. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid and select the “Learn about Medicaid Services” link. To request a written copy of our Medicaid Provider Directory, please contact us.

Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid or www.louisianahealthconnect.com. To request a written copy of our Medicaid Provider Directory, please contact us.

Wellcare By Fidelis Care
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. 

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

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. 

Wellcare Fidelis Dual Align (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 Fidelis Dual Align 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.

When joining this plan: 
1.) You must use in-network providers, DME (durable medical equipment) suppliers, and pharmacies.

2.) You will be enrolled automatically into Medicaid (NJ FamilyCare) coverage under our plan and disenrolled from any Medicaid (NJ FamilyCare) plan you are currently enrolled in. All of your Medicaid-covered services, items, and medications will then be covered under our plan, and you must get them from in-network providers.

3.) You will be enrolled automatically into Part D coverage under our plan, and you will be automatically disenrolled from any other Medicare Part D or creditable coverage plan in which you are currently enrolled. 

4.) You must understand and follow our plan’s rules on referrals.

Paano makakakuha ng pagsaklaw sa panahon ng sakuna o lokal na emergency.

Sakaling magkaroon ng emergency o likas na sakuna, ang Wellcare ay nakatuon sa pagtulong sa inyong patuloy na madaling ma-access ang pangangalaga. Kapag may krisis, ginagawa namin ang sumusunod:

• Payagan ang mga benepisyo ng plano sa Part A at Part B at mga suplemental na benepisyo ng plano sa Part C na maibigay sa mga tinukoy na hindi kinontratang pasilidad (tandaan na ang mga benepisyo sa Part A at Part B ay dapat na ibigay ng mga pasilifdad na sertipikado ng Medicare, alinsunod sa 42 CFR §422.204(b)(3))
• Buong ipinagpapaliban, mga kinakailangan para sa mga referral ng gatekeeper kapag naaangkop
• Pansamantalang ibaba ang wala sa network na halaga ng bahaginan-sa-gastos na inaprubahan ng plano sa halaga ng bahaginan-sa-gastos na nasa network
• Ipagpaliban ang kinakailangang 30 araw na abiso sa mga nagpapatala basta't nakakatulong sa nagpapatala ang lahat ng mga pagbabago (gaya ng pagbabawas sa halaga ng bahaginan-sa-gastos at pagpapaliban ng awtorisasyon)

• Binibigyang-daan kang mag-fill ng mga gamot nang mas maaga kaysa sa karaniwan para matiyak na mayroon ka ng mga kailangan mo sa panahon ng emergency 

Magkakabisa ang mga pagkilos na ito hanggang sa matapos ang panahon ng pagdedeklara ng emergency. Ang Mga Sakuna/Emergency ay maaaring ideklara ng Pamahalaan ng U.S., ng Pederal na Ahensya sa Pamamahala ng Emergency (Federal Emergency Management Agency, FEMA), o ng Gobernador ng anumang estado.

Sa karaniwan, kaklaruhin ng source na nagdeklara ng sakuna kung kailan matatapos ang sakuna o emergency. Gayunpaman, kung hndi pa rin matatapos ang timeframe ng sakuna o emergency sa loob ng 30 araw mula sa inisyal na pagdedeklara, at kung wala pang tinukoy na petsa ng pagtatapos ang Mga Center para sa Mga Serbisyo ng Medicare at Medicaid (Centers for Medicare & Medicaid Services, CMS) para sa sakuna o emergency, babalik na kami sa normal na operasyon pagkalipas ng 30 araw mula sa inisyal na pagdedeklara.