Conceptos básicos de Medicare

Renuncia de Responsabilidades Legales

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

Wellcare es la marca de Medicare para Centene Corporation, un plan HMO, PPO, PFFS, PDP con un contrato de Medicare y es un patrocinador aprobado de la Parte D. Nuestros planes D-SNP tienen un contrato con el programa estatal de Medicaid. La inscripción a nuestros planes depende de la renovación del contrato.

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.

Medicare evalúa los planes en función de un sistema de clasificación de 5 estrellas todos los años.

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. 

Notificación: TennCare no es responsable del pago de estos beneficios, excepto por los montos de costos compartidos correspondientes. TennCare no es responsable de garantizar la disponibilidad o calidad de estos beneficios. Cualquier beneficio que no esté incluido en los beneficios tradicionales de Medicare se aplica solamente a Wellcare Medicare Advantage y no es un indicador de un aumento de los beneficios de 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 contact us.

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.

Cómo tener acceso a la cobertura en caso de que ocurra un desastre o una emergencia local.

En caso de una emergencia o desastre natural, Wellcare está comprometido a ayudarlo a seguir accediendo fácilmente a su atención. En momentos de crisis, nosotros:

• Permitiremos que los beneficios de los planes de las Partes A y B y los beneficios suplementarios de la Parte C se proporcionen en instalaciones específicas no contratadas (tenga en cuenta que los beneficios de las Partes A y B deben proporcionarse en instalaciones certificadas por Medicare, de acuerdo con 42 CFR §422.204(b)(3)).
• Renunciaremos en su totalidad a los requisitos para los filtros de las remisiones cuando corresponda.
• Reduciremos temporalmente los costos compartidos fuera de la red aprobados por el plan a montos compartidos dentro de la red.
• Renunciaremos al requisito de notificación de 30 días para los inscritos siempre y cuando todos los cambios (como la reducción del costo compartido y la autorización de renuncia) beneficien al afiliado.

• Le permitiremos que surta sus medicamentos antes de lo normal para garantizar que tenga lo necesario durante la emergencia

Estas acciones se llevarán a cabo durante el período que se declare de emergencia. El estado de desastres/emergencias puede ser declarado por el Gobierno de los Estados Unidos, la Agencia Federal para el Manejo de las Emergencias (Federal Emergency Management Agency, FEMA) o el gobernador de cualquier estado.

Por lo general, la fuente que declare el desastre aclarará cuando el desastre o la emergencia haya terminado. No obstante, si el período de desastre o emergencia no se ha dado por terminado 30 días después de la declaración inicial, y si los Centros de servicios de Medicare y Medicaid (CMS, Centers for Medicaid and Medicare Services) no han indicado una fecha de finalización del desastre o la emergencia, retomaremos nuestras operaciones normales 30 días después de la declaración inicial.