The Overall Plan Rating combines scores for the types of services each plan offers:
What is being measured?
For plans covering health services, the overall score for quality of those services covers 36 different topics in 5 categories:
Staying healthy: screenings, tests, and vaccines: Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
Ratings of health plan responsiveness and care: Includes ratings of member satisfaction with the plan.
Health plan member complaints and appeal: Includes how often members filed a complaint against the plan.
Health plan telephone customer service: Includes how well the plan handles calls from members.
For plans covering drug services, the overall score for quality of those services covers 17 different topics in 4 categories:
Drug plan customer service: Includes how well the drug plan handles calls and makes decisions about member appeals.
Drug plan member complaints and Medicare audit findings: Includes how often members filed a complaint about the drug plan and findings from Medicare's audit of the plan.
Member experience with drug plan: Includes member satisfaction information.
Drug pricing and patient safety: Includes how well the drug plan prices prescriptions and provides updated information on the Medicare website. Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition.
For plans covering both health & drug services, the overall score for quality of those services covers all of the 53 topics listed above.
Where does the information for the Overall Plan Rating come from?
For quality of health services, the information comes from sources that include:
Member surveys done by Medicare
Information from clinicians
Information submitted by the plans
Results from Medicare's regular monitoring activities
For quality of drug services, the information comes from sources that include:
Results from Medicare's regular monitoring activities
Reviews of billing and other information that plans submit to Medicare
Member surveys done by Medicare
Why is the Overall Plan Rating important?
The Overall Plan Rating gives you a single summary score that makes it easy for you to compare plans based on quality and performance. Learn more about differences among plans by looking at the detailed ratings.
Plan performance summary star ratings are assessed each year and may change from one year to the next.
Source : Medicare.gov
You can always call our licensed agents at
1-800-299-3116
(TTY User: 711) Mon - Fri 8AM - 8PM ET, Sat 9AM - 6PM ET if you have questions, need help comparing plans, or to complete your enrollment.
Health Net of Arizona - We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Health Net of Arizona - Benefits mentioned are a part of Special Supplemental Benefits for the Chronically Ill. Not all members will qualify. In addition to being high-risk, you must have one or more of the following chronic conditions: cancer, cardiovascular disorders, chronic and disabling mental health conditions, chronic lung disorders, diabetes. There are other eligible conditions not listed. Eligibility for this benefit cannot be guaranteed based solely on your condition. All applicable eligibility requirements must be met before the benefit is provided. For details, please contact us or see the plan's Evidence of Coverage/Member Handbook.
Health Net of Arizona - Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.
Health Net of Arizona - Every year, Medicare evaluates plans based on a 5-star rating system.
Health Net of Arizona - 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.
Health Net of Arizona - Notice of Nondiscrimination and Multi-language Interpreter Services - Notice of Availability
Limitations, copayments, and restrictions may apply.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
You must continue to pay your Medicare Part B premium.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your Medicaid Office.
Medicare beneficiaries may also enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
Not every plan is available statewide or in all service areas.
Last Updated Date: 10/22/2016
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Call our Licensed Agents
Phone Number.1-800-299-3116
TTY User: 711
Prescription Drug Coverage
Prescription drug coverage typically means all or part of the cost of prescription drug is covered by this plan. A copay is sometimes required. See the Prescription Drugs section of the Benefit Details page for more information.
Last Updated Date: 10/22/2016
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Prescription Drug Not Covered
The cost of Part D prescription drugs is not covered by this plan. However, there may be stand-alone Part D prescription drug plans available so refer to the quote page for more information.
Last Updated Date: 10/22/2016
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Please select no more than four plans for comparison.
( of 4 plans )
Overall Plan Rating
The Overall Plan Rating combines scores for the types of services each plan offers:
What is being measured?
For plans covering health services, the overall score for quality of those services covers 36 different topics in 5 categories:
Staying healthy: screenings, tests, and vaccines: Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
Ratings of health plan responsiveness and care: Includes ratings of member satisfaction with the plan.
Health plan member complaints and appeal: Includes how often members filed a complaint against the plan.
Health plan telephone customer service: Includes how well the plan handles calls from members.
For plans covering drug services, the overall score for quality of those services covers 17 different topics in 4 categories:
Drug plan customer service: Includes how well the drug plan handles calls and makes decisions about member appeals.
Drug plan member complaints and Medicare audit findings: Includes how often members filed a complaint about the drug plan and findings from Medicare's audit of the plan.
Member experience with drug plan: Includes member satisfaction information.
Drug pricing and patient safety: Includes how well the drug plan prices prescriptions and provides updated information on the Medicare website. Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition.
For plans covering both health & drug services, the overall score for quality of those services covers all of the 53 topics listed above.
Where does the information for the Overall Plan Rating come from?
For quality of health services, the information comes from sources that include:
Member surveys done by Medicare
Information from clinicians
Information submitted by the plans
Results from Medicare's regular monitoring activities
For quality of drug services, the information comes from sources that include:
Results from Medicare's regular monitoring activities
Reviews of billing and other information that plans submit to Medicare
Member surveys done by Medicare
Why is the Overall Plan Rating important?
The Overall Plan Rating gives you a single summary score that makes it easy for you to compare plans based on quality and performance. Learn more about differences among plans by looking at the detailed ratings.
Source : Medicare.gov
Last Updated Date: 10/22/2016
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2012 Plan
2012 Plan means this plan has effective date of January 1, 2012. If you need coverage before 2012, there are 2011 plans available so refer to the quote page for plans with a 2011 PLAN label.
Last Updated Date: 10/22/2016
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2012 Plan
2012 Plan means this plan has effective date of January 1, 2012.
Last Updated Date: 10/22/2016
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2013 Plan
2013 Plan means this plan has effective date of January 1, 2013. If you need coverage before 2013, there are 2012 plans available so refer to the quote page for plans with a 2012 PLAN label.
Last Updated Date: 10/22/2016
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2013 Plan
2013 Plan means this plan has effective date of January 1, 2013.
Last Updated Date: 10/22/2016
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PDP
PDP means Medicare Prescription Drug Plan (or Part D). PDPs are stand-alone drug plans that add prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
A PDP may be right for you if:
You want to stay on Original Medicare.
You have purchased a Medicare Supplement Policy and need prescription coverage.
You have an employer plan that provides hospital and doctor coverage but no prescription drug coverage.
Last Updated Date: 10/22/2016
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PPO
PPO means Preferred Provider Organization. Like the name implies, with a PPO plan, you'll need to receive medical care from the doctors or hospitals on the insurance company's preferred list of providers to have your claims paid at the highest level. You will probably not be required to coordinate your care through a single primary care physician, as you would with an HMO, but it's up to you to make sure that the health care providers you visit participate in the PPO. Services rendered by out-of-network providers may not be covered or may be paid at a lower level. A broad variety of PPO plans are available, many with low monthly premiums.
A PPO may be right for you if:
Your favorite doctor already participates in the PPO.
You want some freedom to direct your own health care but don't mind working within a list of preferred providers.
HMO
HMO means Health Maintenance Organization. HMO plans offer a wide range of health care services through a network of providers that contract exclusively with the HMO, or who agree to provide services to members at a pre-negotiated rate. As a member of an HMO, you will need to choose a primary care physician ("PCP") who will provide most of your health care and refer you to HMO specialists as needed. Some HMO plans require that you fulfill a deductible before services are covered. Others only require you to make a copayment when services are rendered. Health care services obtained outside of the HMO are typically not covered, except in the case of an emergency.
An HMO may be right for you if:
You're willing to play by the rules and coordinate your care through a primary care physician.
You're looking for comprehensive benefits at a reasonable monthly premium.
HMO-POS
HMO-POS means Health Maintenance Organization with a Point of Service option. HMO-POS plans work similarly to the standard HMO plans but with a more flexible network, including the ability for a member to see doctors outside of the HMO network and to self-refer to a specialist doctor. A HMO-POS may allow you to get some services outside the network for a higher copayment or coinsurance.
An HMO-POS may be right for you if:
Your current or preferred doctor does not participate in the HMO network.
You want to see specialists without your primary care physician's referral.
PFFS
PFFS means Private Fee For Service. PFFS plans, offered by private insurers, provide the same benefits as Original Medicare, but may also have additional prescription drug coverage and other benefits. As a member of a PFFS, you can see any doctor that accepts Medicare and your specific PFFS plan. Depending on the insurance company, your plan may also include coverage for vision tests or basic dental care. Most PFFS plans have Part D prescription drug coverage, but you can choose a PFFS plan without drug coverage.
A PFFS may be right for you if:
You want some freedom to choose your own doctor, specialist or hospital without staying in a provider network.
You want predictable copayments for most covered services.
SNP
SNP means Special Needs Plan. SNPs are for people who receive both Medicare and Medicaid (dual eligibles), live in an institution, or who have certain chronic conditions. As a member of a SNP, you will need to choose a primary care physician and generally must get your care and services from providers in the plan's network. Some plans provide out-of-network coverage, usually at a higher cost. SNP plans may include drug coverage.
A SNP may be right for you if:
You qualify for the plan due to a certain chronic condition.
You are looking for additional benefits the SNP plan provides.
Last Updated Date: 10/22/2016
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Monthly Premium
The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage.
Some Medicare Advantage plans have premiums; others do not. In plans without a premium, the federal government pays health insurance companies to provide your Medicare Advantage benefits. Plans with monthly premiums may include extra coverage, including routine eye exams, hearing aids and routine dental care. It is very important to note that with Medicare Advantage plans, you still must pay your Medicare Part B premium.
Last Updated Date: 10/22/2016
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Monthly Premium
The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage.
Last Updated Date: 10/22/2016
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Estimated Annual Savings
The potential savings derived from subtracting the annual cost estimate for the displayed plan from the estimated average retail prices of the drugs entered. The annual cost estimate includes the annual monthly premiums for that particular plan, as well as the associated out-of-pocket expenses for the entered medications under that plan.
Last Updated Date: 10/22/2016
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Office Visit Primary Doctor
Typically, an outpatient visit to the office of a primary care physician (or PCP) for illness or injury.
Last Updated Date: 10/22/2016
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Office Visit Specialist
Typically, an outpatient visit to a medical specialist's office for illness or injury.
Last Updated Date: 10/22/2016
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Doctor Choice
Whether you can choose your hospital or doctor depends on the type of plan. With Original Medicare, you can choose any doctor or hospital that accepts Medicare. Medicare Advantage plans may require you to visit doctors and hospitals in their network. Medicare supplement plans do not have networks; you can see any doctor or hospital that accepts Medicare.
Last Updated Date: 10/22/2016
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Annual Deductible
The amount you must pay for health care or prescriptions, before your coverage begins to pay. For example, in Original Medicare, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.
Last Updated Date: 10/22/2016
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Initial Coverage Limit
The yearly limit to the amount of money you pay out-of-pocket for your drug deductible, coinsurance, copayment for the covered drugs before you reach your plan's coverage gap (also called the "donut hole"). Once this initial coverage limit is reached, you must pay the full cost of your prescription drugs up until the total out of pocket limit is reached. This limit does not include the drug plan's premium and the amount can change each year.
Last Updated Date: 10/22/2016
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Out-of-Pocket Maximum
An annual limitation on the out-of-pocket costs of a health insurance plan. This limit does not apply to premiums, balance-billed charges from out-of-network health care providers, or services that are not covered by the plan.
Last Updated Date: 10/22/2016
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Out-of-Pocket Limit
The yearly total out of pocket expenses you pay for your Medicare covered drug deductible, coinsurance, copayments, and the coverage gap (or "donut hole"). This limit does not include the drug plan's premium and the amount can change each year.
Last Updated Date: 10/22/2016
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Prescription Drug Coverage
All or part of the cost of prescription drug covered by the plan. A co-pay or coinsurance is sometimes required. See the Prescription Drugs section of the Plan Details for more information.
Last Updated Date: 10/22/2016
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Physical Exams
Typically, periodic health exams that occur on a regular basis for preventative purposes, including routine physicals or annual check-ups.
Last Updated Date: 10/22/2016
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Emergency Room
Typically, emergency room services include all services provided when a patient visits an emergency room for an emergency condition. An emergency condition is any medical condition that would lead most lay people to believe that failing to obtain immediate medical care could result in placing the patient's health in serious jeopardy.
Last Updated Date: 10/22/2016
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Ambulance Services
Transport by ambulance to or from a hospital from your home or a medical facility to receive medical care. Medicare covers the following types of ambulance services depending on the seriousness of your medical condition or whether other methods of transportation could endanger your health: emergency ground (vehicle), emergency air (airplane or helicopter) and non-emergency ground.
Last Updated Date: 10/22/2016
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Urgent Care
Care that you get outside of your Medicare health plan's service area for a sudden illness or injury that needs attention but isn't life threatening. If it's not safe to wait until you get home to get care from a plan doctor, the health plan must pay for the care.
Last Updated Date: 10/22/2016
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Outpatient Lab/X-Ray
Labs and X-rays help your doctor diagnose or rule out a medical condition. Lab services typically include blood tests and urinalysis. X-ray services typically include plain-film X-ray, outpatient ultrasound, GI tests, MRIs and CT scans. Depending on the situation, prostate cancer screenings, mammograms and pap smears may also be covered under the lab/X-ray benefit, or they may be covered by the OB-GYN or preventive care benefit. Typically, dental X-rays are not included in the lab/X-ray benefit.
Last Updated Date: 10/22/2016
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Outpatient Surgery
Often defined as any surgical procedure that does not require an overnight stay in a hospital.
Last Updated Date: 10/22/2016
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Hospitalization
Typically includes services related to staying in a hospital for scheduled procedures, accidents, or medical emergencies.
Last Updated Date: 10/22/2016
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Outpatient Rehabilitation Services
Outpatient services help you regain abilities, such as speech or walking, that have been impaired by an illness or injury. These services are provided by nurses, as well as by physical, occupational and speech therapists. Examples include working with a physical therapist to help you walk or working with an occupational therapist to help you get dressed.
Last Updated Date: 10/22/2016
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Skilled Nursing Facility (SNF)
A nursing facility with the staff and equipment to give skilled nursing care and, in most cases, skilled rehabilitative services and other related health services.
Last Updated Date: 10/22/2016
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Home Health Care
Health care services and supplies a doctor decides you may receive in your home under a plan of care established by your doctor. Medicare only covers home health care on a limited basis as ordered by your doctor.
Last Updated Date: 10/22/2016
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Hospice
A special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional and spiritual needs of the patient. Hospice also provides support to the patient's family or caregiver.
Last Updated Date: 10/22/2016
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Prescription Drug Deductible
The amount of prescription drug expenses a member must incur each year before the plan pays prescription drug benefits.
Last Updated Date: 10/22/2016
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Preferred Generic
Typically includes most generic drugs that have been on the market for a time and are widely accepted. Generic drugs are chemically the same as brand-name drugs with regard to their active ingredients, dosage, safety, strength, how they are taken and what they are used to treat. Since generics work the same way in your body, they have the same risks and benefits as brand-name medications. A generic drug is called by its "chemical" name instead of a "brand" name and is typically sold at a lower price. Talk to your doctor about your medication options. In most cases, your doctor can prescribe a generic drug instead of the "brand-name," saving you money when you fill the prescription.
Last Updated Date: 10/22/2016
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Preferred Brand
Typically the brand-name drugs that have been in the market for a time and are widely accepted. May include medications manufactured by one manufacturer that are typically lower-cost among all brand-name drugs.
Last Updated Date: 10/22/2016
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Non-Preferred Generic
Typically the higher-cost generic drugs. In most cases, an alternative preferred medication is available. Because of the high cost of these drugs, the co-payment is also higher than for preferred drugs.
Last Updated Date: 10/22/2016
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Non-Preferred Brand
Typically the higher-cost and/or newer brand-name drugs that have recently come on the market. So-called 'designer' drugs also fall into this category. In most cases, an alternative preferred medication is available. Because of the high cost of these drugs, the co-payment is also higher than for preferred drugs.
Last Updated Date: 10/22/2016
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Specialty Drug
Typically includes unique and often very high-cost medications. You can expect to pay a significant copayment or coinsurance for drugs in this tier.
Last Updated Date: 10/22/2016
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Dental Services
Original Medicare does not cover routine dental care, such as routine checkups, cleaning, fillings or dentures. However, private insurance plans may include certain dental services or discounts, so check the Plan Details of a plan and its plan brochure to see what dental services are covered.
Last Updated Date: 10/22/2016
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Hearing Services
Original Medicare does not cover routine hearing benefits, such as hearing aids or examinations. However, private insurance plan may include certain hearing benefits or discounts, so check the Plan Details of a plan and its plan brochure to see what hearing services are covered.
Last Updated Date: 10/22/2016
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Vision Services
Original Medicare does not cover routine eye services, including eyeglasses and eye exams. However, private insurance plans may include certain vision benefits or discounts, so check the Plan Details of a plan and its plan brochure to see what vision services may be covered.
Last Updated Date: 10/22/2016
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Chiropractic Coverage
Chiropractic services provided by a licensed chiropractor.
Last Updated Date: 10/22/2016
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Outpatient Mental Health
Typically for services provided by a mental health professional in an outpatient program.
Last Updated Date: 10/22/2016
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Low Performering Plan
Medicare has given this plan a low summary rating for 3 years in a row.
