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2019 Summary of Benefits Medicare Advantage Plans
Mississippi
Attala, Bolivar, Carroll, Claiborne, Clarke, Coahoma, Copiah, Covington, DeSoto, Forrest, Grenada, Hinds, Holmes, Humphreys, Issaquena, Jasper, Jefferson Davis, Jones, Kemper, Lafayette, Lamar, Lauderdale, Lawrence, Leake, Lincoln, Madison, Marion, Marshall, Neshoba, Newton, Panola, Pike, Quitman, Rankin, Scott, Sharkey,
Simpson, Smith, Sunflower, Tallahatchie, Tate, Tunica, Walthall, Warren, Washington, Wayne, Yazoo
H1416 | Plan 044
WellCare Liberty (HMO SNP)
H1416_WCM_16186E_M ©WellCare 2018 MS9IMRSOB16186E_0044
2019
Sum
mar
y of B
enef
itsJa
nuar
y 1, 2
019
– D
ecem
ber 3
1, 2
019
All
Wel
lCar
e Lib
erty
(HM
O S
NP)
mem
bers
can
be su
re o
f one
th
ing:
The
qua
lity
of th
eir h
ealth
care
is o
ur to
p pr
iorit
y. T
his i
s a
sum
mar
y of
dru
g an
d he
alth
serv
ices t
hat a
re co
vere
d by
Wel
lCar
e Li
bert
y (H
MO
SN
P).
Thi
s boo
klet
will
giv
e you
a br
ief o
verv
iew
of w
hat w
e cov
er an
d wh
at
mem
bers
can
expe
ct to
pay
, but
doe
s not
list
ever
y ben
efit,
lim
itatio
n
or ex
clusio
n. T
o re
ceiv
e a co
mpl
ete l
ist o
f wha
t the
plan
cove
rs, c
all
Cus
tom
er S
ervi
ce an
d as
k fo
r the
plan
’s “E
vide
nce o
f Cov
erag
e” o
r vi
ew a
copy
on
our w
ebsit
e at w
ww.w
ellc
are.
com
/med
icar
e.
Like
all M
edica
re h
ealth
plan
s, ou
r plan
s also
cove
r eve
ryth
ing
that
O
rigin
al M
edica
re co
vers
with
addi
tiona
l ben
efits
to su
ppor
t you
r we
ll-be
ing.
Thi
s inc
lude
s our
Nur
se A
dvice
Lin
e who
se o
n-ca
ll nu
rses
are a
vaila
ble 2
4-ho
urs a
day
to an
swer
que
stion
s abo
ut y
our h
ealth
ca
re n
eeds
. Yo
u ca
n co
mpa
re th
e cov
erag
e and
costs
in th
is bo
oklet
with
the
cove
rage
and
costs
offe
red
by O
rigin
al M
edica
re b
y lo
okin
g in
you
r cu
rrent
"Med
icare
& Y
ou" h
andb
ook.
You
can
view
it o
nlin
e at
http
://ww
w.m
edic
are.
gov
or g
et a
copy
by
calli
ng
1-80
0-M
ED
ICA
RE
(1-8
00-6
33-4
227)
, 24
hour
s a d
ay, 7
day
s a
week
. TT
Y us
ers s
houl
d ca
ll 1-
877-
486-
2048
.
Whi
ch d
octo
rs, h
ospi
tals
and
phar
mac
ies c
an I
use?
W
ellC
are L
iber
ty (H
MO
SN
P) is
a H
ealth
Mai
nten
ance
O
rgan
izat
ion-
Spec
ial N
eeds
Plan
(HM
O-S
NP)
. Tha
t mea
ns y
ou
mus
t gen
erall
y re
ceiv
e car
e thr
ough
our
net
work
of l
ocal
doct
ors,
ho
spita
ls, an
d ot
her p
rovi
ders
(exc
ept e
mer
genc
y ca
re o
r out
-of-
area
ur
gent
ly n
eede
d se
rvice
s). If
you
use
pro
vide
rs th
at ar
e not
in o
ur
netw
ork,
the p
lan m
ay n
ot p
ay fo
r the
se se
rvice
s.
You
will
gene
rally
hav
e to
use o
ne o
f our
net
work
pha
rmac
ies t
o fil
l yo
ur p
resc
riptio
ns co
vere
d by
Par
t D.
You
can
see o
ur p
lan's
prov
ider
and
phar
mac
y di
rect
ory
and
our
com
plet
e plan
form
ular
y (li
st of
Par
t D p
resc
riptio
n dr
ugs)
at o
ur
webs
ite, w
ww.w
ellc
are.
com
/med
icar
e. O
r call
us a
nd w
e'll s
end
you
a c
opy.
We’r
e her
e with
our
mem
bers
ever
y ste
p of
the w
ay.
How
will
I de
term
ine m
y dru
g co
sts?
T
he co
sts o
f you
r med
icatio
ns ar
e bas
ed o
n a c
ombi
natio
n of
four
im
porta
nt fa
ctor
s: W
hich
med
icatio
n(s)
you
are p
resc
ribed
: Gen
eric
or B
rand
Yo
ur L
ow In
com
e Sub
sidy
(LIS
) or “
Ext
ra H
elp” l
evel
Your
Med
icare
Sav
ings
Pro
gram
(MSP
) lev
el W
hich
stag
e of t
he b
enef
it yo
u ha
ve re
ache
d: D
educ
tible,
Initi
al
Cov
erag
e or C
atas
troph
ic C
over
age
Wha
t is “
Ext
ra H
elp?
” A
Low
Inco
me S
ubsid
y (L
IS),
also
refe
rred
to as
“Ext
ra H
elp,”
may
be
avai
lable
to h
elp y
ou w
ith P
art D
out
-of-
pock
et ex
pens
es su
ch as
pr
emiu
ms,
dedu
ctib
les, c
o-in
sura
nce o
r co-
pays
. Man
y peo
ple q
ualif
y fo
r the
“Ext
ra H
elp” P
rogr
am an
d do
n’t e
ven
know
it. K
eep
in m
ind
th
at as
sista
nce m
ay al
so d
epen
d on
you
r Med
icare
Sav
ings
Pro
gram
(M
SP) l
evel
and
your
dua
l elig
ible
statu
s. T
o fin
d ou
t mor
e inf
orm
atio
n an
d if
you
quali
fy fo
r the
“Ext
ra H
elp”
Prog
ram
, call
the S
ocia
l Sec
urity
Adm
inist
ratio
n at
1-8
00-7
72-1
213,
T
TY
1-80
0-32
5-07
78, 7
:00
a.m. t
o 7:
00 p
.m.,
Mon
day
thru
Frid
ay.
Who
can
join
? T
o jo
in W
ellC
are L
iber
ty (H
MO
SN
P), y
ou m
ust b
e ent
itled
to
Med
icare
Par
t A, r
ecei
ve m
edica
l ass
istan
ce fr
om M
edica
id th
roug
h
1
the M
ississ
ippi
Div
ision
of M
edic
aid
, enr
olled
in M
edica
re P
art B
an
d liv
e in
our s
ervi
ce ar
ea. O
ur se
rvice
area
inclu
des t
he fo
llowi
ng
coun
ties i
n M
S: A
ttala,
Bol
ivar,
Car
roll,
Clai
born
e, C
larke
, Coa
hom
a,
Cop
iah,
Cov
ingt
on, D
eSot
o, F
orre
st, G
rena
da, H
inds
, Hol
mes
, H
umph
reys
, Iss
aque
na, J
aspe
r, Je
ffers
on D
avis,
Jone
s, K
empe
r,
Lafa
yette
, Lam
ar, L
aude
rdale
, Law
renc
e, Le
ake,
Linc
oln,
Mad
ison,
M
ario
n, M
arsh
all, N
esho
ba, N
ewto
n, P
anol
a, Pi
ke, Q
uitm
an, R
anki
n,
Scot
t, Sh
arke
y, S
imps
on, S
mith
, Sun
flowe
r, T
allah
atch
ie, T
ate,
T
unica
, Walt
hall,
War
ren,
Was
hing
ton,
Way
ne, Y
azoo
.
Und
erst
andi
ng D
ual E
ligib
ility
M
edica
id is
a jo
int F
eder
al an
d sta
te g
over
nmen
t pro
gram
that
help
s wi
th m
edica
l cos
ts fo
r cer
tain
peo
ple w
ith li
mite
d in
com
es an
d
reso
urce
s. M
edica
id co
vera
ge va
ries d
epen
ding
on
the s
tate
and
the
type
of M
edica
id y
ou h
ave.
Wha
t you
pay
for c
over
ed se
rvice
s may
de
pend
on
your
leve
l of M
edica
id el
igib
ility
. Som
e peo
ple w
ith
Med
icaid
get
help
pay
ing
for t
heir
Med
icare
pre
miu
ms a
nd o
ther
co
sts. O
ther
peo
ple m
ay al
so g
et co
vera
ge fo
r add
ition
al se
rvice
s and
dr
ugs t
hat a
re co
vere
d un
der M
edica
id b
ut n
ot b
y M
edica
re.
In o
rder
for y
ou to
bet
ter u
nder
stand
you
r hea
lthca
re o
ptio
ns, t
he
follo
wing
belo
w pr
ovid
es y
ou w
ith in
form
atio
n ab
out t
he M
edica
id
porti
on o
f you
r dua
l elig
ibili
ty. M
edica
id b
enef
its ar
e valu
able
to yo
u
beca
use t
he st
ate p
rovi
des a
dditi
onal
healt
hcar
e cov
erag
e and
fina
ncial
su
ppor
t bas
ed o
n yo
ur M
edica
re S
avin
gs P
rogr
am (M
SP) a
id le
vel a
s se
en b
elow:
Fu
ll-Be
nefit
Dua
l Elig
ible
(FBD
E):
Med
icaid
will
pay
for y
our
Med
icare
Par
t A &
B p
rem
ium
s, de
duct
ibles
, co-
insu
ranc
es, a
nd
co-p
aym
ents.
Elig
ible
bene
ficiar
ies al
so re
ceive
full
Med
icaid
ben
efits
. Q
ualif
ied
Med
icar
e Ben
efic
iary
(QM
B): M
edica
id w
ill p
ay fo
r you
r M
edica
re P
art A
& B
pre
miu
ms,
dedu
ctib
les, c
o-in
sura
nces
, and
co
-pay
men
ts. (S
ome p
eopl
e with
QM
B ar
e also
elig
ible
for f
ull
Med
icaid
ben
efits
(QM
B+))
Spec
ified
Low
-Inc
ome M
edic
are B
enef
icia
ry (S
LMB
): M
edica
id
will
abso
rb th
e cos
t of y
our M
edica
re P
art B
Pre
miu
ms.
Som
e peo
ple
with
SLM
B ar
e also
elig
ible
for f
ull M
edica
id b
enef
its (S
LMB+
) N
ote:
Som
e MSP
Lev
els au
tom
atica
lly q
ualif
y fo
r “E
xtra
Help
” for
M
edica
re p
resc
riptio
n dr
ug co
vera
ge as
sista
nce.
For e
ach
bene
fit li
sted
belo
w, y
ou ca
n se
e wha
t our
plan
cove
rs in
ad
ditio
n to
wha
t Miss
issip
pi D
ivisi
on of
Med
icai
d co
vers.
No m
atte
r wh
at y
our l
evel
of M
edica
id el
igib
ility
is, W
ellC
are L
iber
ty (H
MO
SN
P) w
ill co
ver t
he b
enef
its as
des
crib
ed in
the p
lan’s
colu
mn.
If yo
u
have
que
stion
s abo
ut yo
ur M
edica
id el
igib
ility
and
what
ben
efits
you
ar
e ent
itled
to, c
all: 1
-855
-292
-023
7.
Thi
s doc
umen
t is a
vaila
ble i
n lan
guag
es o
ther
than
Eng
lish.
For
ad
ditio
nal i
nfor
mat
ion,
call
us at
1-8
77-3
74-4
056,
(TT
Y 71
1).
Thi
s boo
klet
is al
so av
ailab
le in
diff
eren
t for
mat
s, in
cludi
ng B
raill
e,
large
prin
t and
audi
o co
mpa
ct d
isc (C
D).
2
Sum
mar
y of B
enef
its
Janu
ary 1
, 201
9– D
ecem
ber 3
1, 2
019
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
Plan
Bas
ics
$0.0
0 M
onth
ly P
lan
Prem
ium
W
hat Y
ou S
houl
d K
now:
Yo
ur m
onth
ly p
lan p
rem
ium
may
be a
s low
as $
0,
depe
ndin
g on
you
r lev
el of
“Ext
ra H
elp.”
You
m
ust c
ontin
ue to
pay
you
r Med
icare
Par
t B
prem
ium
. If y
ou m
eet c
erta
in el
igib
ility
re
quire
men
ts fo
r bot
h M
edica
re an
d M
edica
id,
your
Par
t B p
rem
ium
s may
be c
over
ed in
full.
$0
A
nnua
l Med
ical
Ded
uctib
le
Wha
t You
Sho
uld
Kno
w:
Thi
s plan
doe
s not
hav
e an
Ann
ual M
edica
l D
educ
tible.
See
Pre
scrip
tion
Dru
g Ben
efits
belo
w
for P
art D
Pre
scrip
tion
Dru
g D
educ
tible
. $6
,700
annu
ally
Max
imum
Out
-of-
Pock
et R
espo
nsib
ility
(doe
s not
inclu
de p
resc
riptio
n dr
ugs)
Wha
t You
Sho
uld
Kno
w:
Our
plan
pro
tect
s you
by
havi
ng y
early
lim
its o
n
your
out
-of-
pock
et co
sts fo
r med
ical a
nd h
ospi
tal
care
. T
his i
s the
mos
t you
pay
for c
o-pa
ys, c
o-in
sura
nce
and
othe
r cos
ts fo
r in-
netw
ork
hosp
ital a
nd
med
ical s
ervi
ces.
If yo
u re
ach
the l
imit
on o
ut-o
f-po
cket
costs
, you
wi
ll ke
ep g
ettin
g co
vere
d ho
spita
l and
med
ical
serv
ices a
nd w
e will
pay
the f
ull c
ost f
or th
e res
t of
the y
ear.
3
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
Dep
endi
ng on
your
leve
l of M
ississ
ippi
Div
ision
of
Med
icai
d el
igib
ility
, you
may
pay
not
hing
for
Med
icare
-cov
ered
serv
ices.
Ref
er to
the “
Med
icare
& Y
ou” h
andb
ook
for
Med
icare
-cov
ered
serv
ices.
For M
ississ
ippi
D
ivisi
on o
f Med
icai
d -c
over
ed se
rvice
s, re
fer t
o
the M
edica
id C
over
age s
ectio
n in
this
docu
men
t. Pl
ease
not
e tha
t you
may
still
nee
d to
pay
you
r m
onth
ly p
rem
ium
s and
cost-
shar
ing
for y
our
Part
D p
resc
riptio
n dr
ugs,
depe
ndin
g on
you
r lev
el of
“Ext
ra H
elp.”
4
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
CO
VER
ED
ME
DIC
AL
AN
D H
OSP
ITA
L BE
NE
FIT
S 1
Ser
vice
s may
requ
ire p
rior a
utho
rizat
ion
2 S
ervi
ces m
ay re
quire
a re
ferr
al fr
om yo
ur d
octo
r 3
Ser
vice
s and
/or c
ost-
shar
e may
vary
dep
endi
ng o
n yo
ur le
vel o
f Med
icai
d Fo
r dua
l-elig
ible
mem
bers
, Med
icaid
pay
s co
-insu
ranc
e, co
-pay
men
ts an
d de
duct
ibles
for
Med
icare
cove
red
serv
ices.
The
Div
ision
of M
edica
id p
ays f
or al
l med
ically
ne
cess
ary
serv
ices f
or E
PSD
T-e
ligib
le
bene
ficia
ries i
n ac
cord
ance
with
Par
t 223
of T
itle
23, w
ithou
t reg
ard
to se
rvice
lim
itatio
ns an
d wi
th
prio
r aut
horiz
atio
n.
$3 co
-pay
for M
edica
id-c
over
ed se
rvice
s.
$0 co
-pay
up
to 9
0 da
ys p
er ad
miss
ion
Inpa
tient
Hos
pita
l Cov
erag
e1
23
Out
patie
nt H
ospi
tal C
over
age,
Sur
gery
and
Se
rvic
es 1
23
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
The
Div
ision
of M
edica
id p
ays f
or al
l med
ically
ne
cess
ary
serv
ices f
or E
PSD
T-e
ligib
le
bene
ficia
ries i
n ac
cord
ance
with
Par
t 223
of T
itle
23, w
ithou
t reg
ard
to se
rvice
lim
itatio
ns an
d wi
th
prio
r aut
horiz
atio
n.
Co-i
nsur
ance
may
appl
y.
$0 C
o-pa
y
Am
bulat
ory
Surg
ical C
ente
r
5
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
$0
Co-
pay
for n
on-s
urgi
cal s
ervi
ces
Out
patie
nt H
ospi
tal
$0 C
o-pa
y fo
r sur
gica
l ser
vice
s
Doc
tor V
isits
12
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Med
icaid
pay
s for
12
offic
e visi
ts pl
us a
phys
ical
exam
from
July
1 to
June
30
each
yea
r. T
he
Div
ision
of M
edica
id p
ays f
or al
l med
ically
ne
cess
ary
serv
ices f
or E
PSD
T-e
ligib
le
bene
ficia
ries i
n ac
cord
ance
with
Par
t 223
of T
itle
23, w
ithou
t reg
ard
to se
rvice
lim
itatio
ns an
d wi
th
prio
r aut
horiz
atio
n.
$3 co
-pay
for M
edica
id-c
over
ed se
rvice
s.
$0 C
o-pa
y
Prim
ary
Car
e Phy
sicia
n
6
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
$0
Co-
pay
Spec
ialis
t
$0
Co-
pay
for e
ach
in-n
etwo
rk vi
sit to
oth
er
healt
h ca
re p
rofe
ssio
nals,
such
as a
Phys
ician
’s
Ass
istan
t or N
urse
Pra
ctiti
oner
, in
a PC
P of
fice
for M
edica
re-c
over
ed se
rvice
s.
Oth
er H
ealth
Car
e Pro
fess
iona
ls
$0 C
o-pa
y fo
r eac
h in
-net
work
visit
to o
ther
he
alth
care
pro
fess
iona
ls, su
ch as
a Ph
ysici
an’s
A
ssist
ant o
r Nur
se P
ract
ition
er, i
n a S
pecia
list’s
of
fice f
or M
edica
re-c
over
ed se
rvice
s. $0
Co-
pay
for e
ach
in-n
etwo
rk vi
sit to
oth
er
healt
h ca
re p
rofe
ssio
nals
in a
clini
c or p
harm
acy
se
tting
for M
edica
re-c
over
ed se
rvice
s. W
hat Y
ou S
houl
d K
now:
Yo
ur p
rimar
y ca
re p
hysic
ian
is th
e doc
tor w
ho
will
hand
le m
ost o
f you
r hea
lth ca
re se
rvice
s. T
hey
will
refe
r you
to sp
ecia
lists
when
nee
ded.
Fo
r dua
l-elig
ible
mem
bers
, Med
icaid
pay
s co
-insu
ranc
e, co
-pay
men
ts an
d de
duct
ibles
for
$0 C
o-pa
y
Prev
entiv
e Car
e A
bdom
inal
aorti
c ane
urys
m sc
reen
ing;
Alco
hol
misu
se co
unse
ling;
Bon
e mas
s mea
sure
men
t; M
edica
re co
vere
d se
rvice
s. W
hat Y
ou S
houl
d K
now:
D
urin
g a c
olon
osco
py th
at is
bei
ng co
mpl
eted
as
a pre
vent
ive s
cree
ning
, abn
orm
al tis
sue a
nd/o
r po
lyp re
mov
al wi
ll be
cove
red
at a
$0 co
-pay
men
t.
Brea
st ca
ncer
scre
enin
g (m
amm
ogra
m);
C
ardi
ovas
cular
dise
ase (
beha
vior
al th
erap
y);
Car
diov
ascu
lar sc
reen
ings
; Cer
vica
l and
vagi
nal
canc
er sc
reen
ing;
Col
orec
tal c
ance
r scr
eeni
ngs
Bone
Mas
s Mea
sure
men
t (fo
r peo
ple w
ith M
edica
re w
ho ar
e at r
isk)
• Bon
e Den
sity
Stud
ies f
or m
embe
rs o
ver a
ge 6
5 A
ny ad
ditio
nal p
reve
ntiv
e ser
vice
s app
rove
d by
M
edica
re d
urin
g the
cont
ract
year
will
be c
over
ed.
(col
onos
copy
, fec
al oc
cult
bloo
d te
st, fl
exib
le
sigm
oido
scop
y); D
epre
ssio
n sc
reen
ing;
Dia
bete
s C
olor
ecta
l Scr
eeni
ng E
xam
s (fo
r peo
ple w
ith M
edica
re ag
e 50
and
olde
r) sc
reen
ings
; HIV
scre
enin
g; M
edica
l nut
ritio
n • C
an b
e les
s tha
n 50
if id
entif
ied
as h
igh
risk.
th
erap
y se
rvice
s; O
besit
y sc
reen
ing
and
• Flex
ible
sigm
oido
scop
y or
bar
ium
enem
a is
coun
selin
g; P
rosta
te ca
ncer
scre
enin
gs (P
SA);
cove
red
ever
y 5
year
s or a
colo
nosc
opy
ever
y 10
Se
xuall
y tra
nsm
itted
infe
ctio
ns sc
reen
ing
and
year
s. co
unse
ling;
Tob
acco
use
cess
atio
n co
unse
ling
7
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
(cou
nseli
ng fo
r peo
ple w
ith n
o sig
n of
to
bacc
o-re
lated
dise
ase)
; Vac
cines
, inc
ludi
ng F
lu
Car
diov
ascu
lar S
cree
ning
sDia
bete
s sh
ots,
Hep
atiti
s B sh
ots,
Pneu
moc
occa
l sho
ts;
Scre
enin
gsFl
u Sh
otsG
lauc
oma
"Welc
ome t
o M
edica
re" p
reve
ntiv
e visi
t (o
ne-t
ime)
; Ann
ual W
ellne
ss vi
sit
Tes
tingH
epat
itis B
Sho
tsIm
mun
izat
ions
(F
lu va
ccin
e, H
epat
itis B
vacc
ine -
for p
eopl
e with
M
edica
re w
ho ar
e at r
isk, P
neum
onia
vacc
ine,
R
abie
s, T
etan
us, H
PV, V
arice
lla an
d H
erpe
s Z
oste
r per
CD
C re
com
men
datio
ns )
Mam
mog
ram
s (A
nnua
l Scr
eeni
ng)
(for w
omen
with
Med
icare
age 4
0 an
d ol
der)
Pap
Smea
rs an
d Pe
lvic
Exa
ms (
Ann
ual
Scre
enin
g)
(Cer
vical
and
vagi
nal c
ance
r scr
eeni
ngs f
or w
omen
wi
th M
edica
re)
Pros
tate
Can
cer S
cree
ning
Exa
ms
(for m
en w
ith M
edica
re ag
e 45
and
olde
r)
Ann
ual W
elln
ess V
isitC
o-in
sura
nce m
ay ap
ply.
Em
erge
ncy C
are
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
$0 C
o-pa
y W
hat Y
ou S
houl
d K
now:
If
you
are a
dmitt
ed to
the h
ospi
tal w
ithin
24
ho
urs,
you
do n
ot h
ave t
o pa
y yo
ur sh
are o
f the
co
st fo
r em
erge
ncy
serv
ices.
Em
erge
ncy
Visi
t
8
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Co-i
nsur
ance
may
appl
y.
$0 C
o-pa
y W
hat Y
ou S
houl
d K
now:
If
you
are a
dmitt
ed to
the h
ospi
tal w
ithin
24
ho
urs,
you
do n
ot h
ave t
o pa
y yo
ur sh
are o
f the
co
st fo
r urg
ently
nee
ded
serv
ices.
Urg
ently
Nee
ded
Serv
ices
Dia
gnos
tic S
ervi
ces/
Labs
/ Im
agin
g1
23
$0 C
o-pa
y whe
n pe
rform
ed at
a sp
ecia
list's
offi
ce
or fr
ee st
andi
ng fa
cility
and
$0 C
o-pa
y wh
en
serv
ices a
re p
erfo
rmed
in an
out
patie
nt se
tting
Dia
gnos
tic R
adio
logy
(MR
Is, C
T sc
ans)
$0 C
o-pa
y fo
r bas
ic di
agno
stic t
ests
and
pr
oced
ures
D
iagn
ostic
Tes
ts an
d Pr
oced
ures
$0 C
o-pa
y fo
r adv
ance
d di
agno
stic t
ests
and
pr
oced
ures
such
as a
card
iac s
tress
test
Fo
r dua
l-elig
ible
mem
bers
, Med
icaid
pay
s co
-insu
ranc
e, co
-pay
men
ts an
d de
duct
ibles
for
Med
icare
cove
red
serv
ices.
C
o-in
sura
nce m
ay ap
ply.
$0 C
o-pa
y
Lab
Serv
ices (
Med
icare
appr
oved
lab
work
)
$0 C
o-pa
y O
utpa
tient
X-R
ays
$0 C
o-pa
y T
hera
peut
ic Ra
diol
ogy S
ervic
es (e
.g., r
adiat
ion
tre
atm
ent f
or ca
ncer
)
$0
Co-
pay
Rela
ted
Med
ical S
uppl
ies
9
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
Hea
ring
Serv
ices
12
3
Hea
ring
Exa
m
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Co-
insu
ranc
e may
appl
y.
$0 C
o-pa
y
Med
icare
Cov
ered
$0 C
o-pa
y R
outin
e Hea
ring
Exa
m
1
Eve
ry y
ear
Thi
s ben
efit
cove
rs $
750
per e
ar ev
ery
year
, co
verin
g 2
ears
with
a m
axim
um o
f $1,
500
towa
rds t
he p
urch
ase o
f 2 h
earin
g ai
ds
Ann
ual H
earin
g A
id A
llowa
nce
$0 C
o-pa
y H
earin
g A
id F
ittin
gs/E
valu
atio
n
1 E
very
yea
r
Wha
t You
Sho
uld
Kno
w:
M
edica
re co
vers
dia
gnos
tic h
earin
g an
d ba
lance
ex
ams i
f you
r doc
tor o
r oth
er h
ealth
care
pro
vide
r or
ders
thes
e tes
ts to
see i
f you
nee
d m
edica
l tre
atm
ent.
Dia
gnos
tic h
earin
g an
d ba
lance
evalu
atio
ns
perfo
rmed
by
your
pro
vide
r to
dete
rmin
e if y
ou
need
med
ical t
reat
men
t are
cove
red
as o
utpa
tient
ca
re w
hen
furn
ished
by
a phy
sicia
n, au
diol
ogist
, or
oth
er q
ualif
ied
prov
ider
. T
his p
lan co
vers
1 ro
utin
e hea
ring
scre
enin
g pe
r ye
ar.
10
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Co-
insu
ranc
e may
appl
y.
You
pay
noth
ing
for t
he fo
llowi
ng p
reve
ntiv
e de
ntal
serv
ices:
Clea
ning
(for
up
to 2
ever
y ye
ar)
Den
tal x
-ray
(s) (f
or u
p to
1 ev
ery
12 to
36
m
onth
s) O
ral e
xam
(for
up
to 1
ever
y six
mon
ths)
Fluo
ride t
reat
men
t (fo
r up
to 1
ever
y ye
ar)
Den
tal S
ervi
ces
12
3
Our
plan
pay
s up
to $
250
per c
alend
ar q
uarte
r wi
th a
max
imum
of $
1000
ever
y ye
ar fo
r mos
t de
ntal
serv
ices.
Unu
sed
amou
nts c
arry
ove
r to
the
next
calen
dar q
uarte
r, bu
t not
the n
ext c
alend
ar
year
. Add
ition
al co
mpr
ehen
sive d
enta
l ser
vice
s yo
u wi
ll pa
y no
thin
g fo
r inc
lude
one
of t
he
follo
wing
: one
endo
dont
ic pr
oced
ure p
er ye
ar, o
ne
perio
dont
ics p
roce
dure
ever
y 6
to 3
6 m
onth
s or
one e
xtra
ctio
n pe
r yea
r. A
lso in
clude
d is
one
pros
thod
ontic
pro
cedu
re ev
ery
12 to
60
mon
ths,
on
e ora
l max
illof
acia
l pro
cedu
re ev
ery 6
0 m
onth
s or
oth
er se
rvice
s eve
ry 6
to 2
4 m
onth
s. T
he d
enta
l ben
efits
on
this
plan
inclu
de co
vera
ge
of p
reve
ntiv
e and
com
preh
ensiv
e ser
vice
s up
to
$100
0, in
cludi
ng b
ut n
ot li
mite
d to
clea
ning
s,
x-ra
y(s),
ora
l exa
ms,
fluor
ide t
reat
men
t, fil
lings
, de
ntur
es o
r a b
ridge
or a
crow
n an
d a r
oot c
anal.
Vi
sion
Serv
ices
12
3
Eye
Exa
ms
$0 fo
r Med
icare
-cov
ered
dia
bete
s ret
inop
athy
sc
reen
ing
and
a $0
Co-
pay
for a
ll ot
her
Med
icare
-cov
ered
eye e
xam
s
Med
icare
Cov
ered
11
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Bene
ficia
ries a
re al
lowe
d on
e (1)
com
plet
e pai
r of
eyeg
lasse
s eve
ry fi
ve (5
) yea
rs. P
rior a
utho
rizat
ion
is
not r
equi
red
unles
s man
ually
pric
ed co
des a
re
used
. Thi
s inc
lude
s eye
glas
s len
ses a
nd fr
ames
.
The
Div
ision
of M
edica
id p
ays f
or al
l med
ically
ne
cess
ary
serv
ices f
or E
PSD
T-e
ligib
le
bene
ficia
ries i
n ac
cord
ance
with
Par
t 223
of T
itle
23, w
ithou
t reg
ard
to se
rvice
lim
itatio
ns an
d wi
th
prio
r aut
horiz
atio
n.
Co-i
nsur
ance
may
appl
y.
$0 C
o-pa
y R
outin
e Eye
Exa
ms
1
Eve
ry y
ear
Eye
wear
12
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
$0
Co-
pay
Med
icare
Cov
ered
Yo
u pa
y a $
0 co
-pay
for 1
rout
ine e
ye ex
am ev
ery
year
. Our
plan
pay
s up
to $
300
ever
y ye
ar fo
r up
to
2 p
airs o
f con
tact
lens
es, e
yegl
asse
s (fra
mes
and
len
ses),
eyeg
lass f
ram
es o
r eye
glas
s len
ses.
Con
tact
Len
ses,
Eye
Glas
ses,
Eye
Glas
s Le
nses
, Eye
Glas
s Fra
mes
If yo
u ch
oose
to g
et 2
pai
rs o
f eye
wear
, the
y mus
t bo
th b
e obt
aine
d in
the s
ame v
isit.
Wha
t You
Sho
uld
Kno
w:
Yo
u pa
y not
hing
for M
edica
re-c
over
ed G
lauco
ma
scre
enin
gs. T
hese
scre
enin
gs ar
e im
porta
nt fo
r ea
rly d
etec
tion
and
prev
entio
n of
Glau
com
a. Yo
u pa
y no
thin
g fo
r eye
glas
ses o
r con
tact
lens
es
afte
r cat
arac
t sur
gery
.
M
enta
l Hea
lth S
ervi
ces
12
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
$0 co
-pay
up
to 9
0 da
ys p
er ad
miss
ion
In
patie
nt H
ospi
tal V
isits
$0
Co-
pay
Out
patie
nt In
divi
dual
The
rapy
$0
Co-
pay
Out
patie
nt G
roup
The
rapy
$0
Co-
pay
Parti
al H
ospi
taliz
atio
n
13
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Med
icaid
pay
s for
nur
sing
facil
ity ca
re,
inte
rmed
iate
care
facil
ity se
rvice
s for
the
Indi
vidu
als w
ith In
telle
ctua
l Disa
bilit
ies,
and
ps
ychi
atric
resid
entia
l tre
atm
ent f
acili
ty ca
re
(und
er ag
e 21)
Co-i
nsur
ance
may
appl
y.
$0 co
-pay
per
day
for D
ays 1
-100
W
hat Y
ou S
houl
d K
now:
O
ur p
lan co
vers
up
to 1
00 d
ays p
er b
enef
it pe
riod
in
a SN
F. A
Ben
efit
Perio
d be
gins
the f
irst d
ay
you
go in
to a
facil
ity (a
cute
inpa
tient
, lon
g te
rm
care
acut
e or S
NF)
and
ends
whe
n yo
u ha
ven’
t re
ceiv
ed an
y in
patie
nt fa
cility
care
for 6
0
cons
ecut
ive d
ays.
The
re is
no
limit
to th
e num
ber
of b
enef
it pe
riods
you
may
hav
e.
Skill
ed N
ursin
g Fa
cilit
y (SN
F)1
23
Phys
ical
The
rapy
12
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Co-i
nsur
ance
may
appl
y.
$0 C
o-pa
y
Occ
upat
iona
l The
rapy
Visi
t
$0
Co-
pay
Phys
ical,
Spee
ch, L
angu
age T
hera
py
14
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
$3 co
-pay
for M
edica
id-c
over
ed se
rvice
s.
$0 C
o-pa
y
Am
bula
nce
13
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Med
icaid
will
help
elig
ible
pers
ons t
o tra
vel t
o
and
from
med
ical a
ppoi
ntm
ents
when
they
hav
e no
oth
er w
ay to
get
ther
e. C
all 1
-866
-331
-600
4
to fi
nd o
ut h
ow to
get
help
with
tran
spor
tatio
n
to y
our a
ppoi
ntm
ent.
Co-i
nsur
ance
may
appl
y.
$0 C
o-pa
y fo
r 36
One
-way
trip
s eve
ry ye
ar
Wha
t You
Sho
uld
Kno
w:
The
firs
t ste
p to
stay
ing
healt
hy is
get
ting
to yo
ur
doct
or. T
hat’s
why
we c
over
thes
e non
-em
erge
ncy,
sh
ared
trip
s to
plan
appr
oved
loca
tions
in th
e pl
an’s
serv
ice ar
ea.
We w
ant t
o m
ake s
ure y
ou g
et th
e car
e you
nee
d,
when
you
need
it. C
all C
usto
mer
Ser
vice 7
2 ho
urs
in ad
vanc
e to
rese
rve a
ride
for y
our a
ppoi
ntm
ent.
Tra
nspo
rtat
ion
12
3
Med
icar
e Par
t B D
rugs
13
Not
App
licab
le $0
Co-
pay
Che
mot
hera
py d
rugs
$0
Co-
pay
Oth
er P
art B
dru
gs
15
Wel
lCar
e Lib
erty
(HM
O S
NP)
Part
D C
ost S
hare
s PR
ESC
RIP
TIO
N D
RU
G B
EN
EFI
TS
Afte
r you
pay
you
r ded
uctib
le, Y
ou p
ay th
e fol
lowi
ng co
-pay
s or c
o-in
sura
nce a
mou
nts u
ntil
your
to
tal y
early
dru
g co
sts re
ach
$3,8
20. T
otal
year
ly d
rug
costs
are t
he to
tal d
rug
costs
pai
d by
bot
h yo
u
and
our P
art D
plan
. You
may
get
you
r dru
gs at
net
work
reta
il an
d m
ail o
rder
pha
rmac
ies.
Initi
al C
over
age S
tage
If yo
u re
side i
n a l
ong
term
care
(LT
C) f
acili
ty, y
ou p
ay th
e sam
e as a
reta
il ph
arm
acy.
Whe
n yo
u
mov
e fro
m o
ne p
hase
of t
he P
art D
ben
efit
to an
othe
r, yo
ur co
st-sh
arin
g m
ay ch
ange
as w
ell. F
or
mor
e inf
orm
atio
n on
the a
dditi
onal
phar
mac
y spe
cific
cost-
shar
ing a
nd th
e pha
se o
f the
ben
efit,
plea
se
call
us o
r acc
ess o
ur E
vide
nce o
f Cov
erag
e onl
ine.
Pref
erre
d M
ail O
rder
R
etai
l In
itial
Cov
erag
e (A
fter y
ou pa
y you
r ded
uctib
le,
if ap
plic
able
) 90
-Day
Sup
ply
30
-Day
Sup
ply
$0
$0, $
1.25
, or $
3.40
T
ier 1
: Pre
ferr
ed G
ener
ic
Gen
erics
: $0
, $1.
25, o
r $3.
40
Tie
r 2: G
ener
ic
Bran
ds: $
0, $
3.80
, or $
8.50
T
ier 3
: Pre
ferr
ed B
rand
Tie
r 4: N
on-P
refe
rred
Dru
g
N/A
G
ener
ics:
$0, $
1.25
, or $
3.40
T
ier 5
: Spe
cial
ty
Bran
ds: $
0, $
3.80
, or $
8.50
Mos
t Med
icare
dru
g pl
ans h
ave a
cove
rage
gap
(also
calle
d th
e “do
nut h
ole”
). T
his m
eans
that
ther
e’s
a tem
pora
ry ch
ange
in w
hat y
ou w
ill p
ay fo
r you
r dru
gs. T
he co
vera
ge g
ap b
egin
s afte
r the
tota
l yea
rly
drug
cost
(inclu
ding
wha
t our
plan
has
pai
d an
d wh
at y
ou h
ave p
aid)
reac
hes $
3,82
0.
Cov
erag
e Gap
Sta
ge
Thi
s sta
ge d
oes n
ot ap
ply
to y
ou.
Afte
r you
r yea
rly o
ut-o
f-po
cket
dru
g co
sts (n
ot in
cludi
ng w
hat t
he p
lan h
as p
aid,
but
inclu
ding
dru
gs
you
purc
hase
d th
roug
h yo
ur re
tail
phar
mac
y and
thro
ugh
mai
l ord
er) r
each
$5,
100,
you
pay n
othi
ng.
Cat
astr
ophi
c Cov
erag
e
16
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
Add
ition
al C
over
ed B
enef
its
Reh
abili
tatio
n Se
rvic
es1
23
For
dua
l-elig
ible
mem
bers
, Med
icaid
pay
s co
insu
ranc
e, co
-pay
men
ts an
d de
duct
ibles
for
Med
icare
cove
red
serv
ices.
Co-i
nsur
ance
may
appl
y.
$0 C
o-pa
y
C
ardi
ac (H
eart)
Reh
abili
tatio
n Se
rvice
s
$0
Co-
pay
Pulm
onar
y R
ehab
ilita
tion
Foot
Car
e (Po
diat
ry
Serv
ices
)1
23
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Co-i
nsur
ance
may
appl
y.
$0 C
o-pa
y
Med
icare
Cov
ered
$0
Co-
pay
W
hat Y
ou S
houl
d K
now:
A
dditi
onal
Rou
tine P
odia
try S
ervi
ces
Foot
exam
s and
trea
tmen
t ava
ilabl
e if y
ou h
ave
diab
etes
-rela
ted
nerv
e dam
age a
nd/o
r mee
t cer
tain
co
nditi
ons.
Add
ition
al ro
utin
e pod
iatry
serv
ices
are n
ot co
vere
d
17
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
Med
ical
Equ
ipm
ent/
Supp
lies
13
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
$3 co
-pay
for M
edica
id-c
over
ed se
rvice
s.
$0 C
o-pa
y
D
urab
le M
edica
l Equ
ipm
ent (
e.g., w
heelc
hairs
, ox
ygen
)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. $3
co-p
ay fo
r Med
icaid
-cov
ered
serv
ices.
$0 C
o-pa
y
Pros
thet
ics (e
.g.,
brac
es, a
rtific
ial l
imbs
)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
$0 C
o-pa
y
D
iabe
tes M
onito
ring
Supp
lies
$0 C
o-pa
y
D
iabe
tic T
hera
peut
ic Sh
oes o
r Ins
erts
$0
Co-
pay
Dia
betic
Self
-Man
agem
ent T
rain
ing
Wha
t You
Sho
uld
Kno
w:
Cov
ered
dia
bete
s sup
plie
s inc
lude
: blo
od g
luco
se
mon
itor,
bloo
d gl
ucos
e tes
t stri
ps, l
ance
t dev
ices
and
lance
ts, an
d gl
ucos
e-co
ntro
l sol
utio
ns.
18
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
W
elln
ess P
rogr
ams
$0 C
o-pa
y Fi
tnes
s $0
Co-
pay
Pe
rson
al E
mer
genc
y R
espo
nse S
yste
m
(PE
RS)
$0
Co-
pay
Add
ition
al R
outin
e Ann
ual P
hysic
al
$0 C
o-pa
y 24
-Hou
r Nur
se A
dvice
Lin
e
W
hat Y
ou S
houl
d K
now:
Well
ness
pro
gram
s are
a gr
eat w
ay to
mai
ntai
n
your
hea
lth. W
heth
er it
’s an
extra
chec
kup
durin
g th
e yea
r or y
ou ju
st ha
ve a
simpl
e hea
lth q
uesti
on,
we ar
e her
e as y
our p
artn
er in
hea
lth.
Chi
ropr
actic
Car
e1
23
$0 C
o-pa
y M
edica
re C
over
ed
$0 C
o-pa
y R
outin
e Chi
ropr
actic
Ser
vice
s Fo
r dua
l-elig
ible
mem
bers
, Med
icaid
pay
s co
-insu
ranc
e, co
-pay
men
ts an
d de
duct
ibles
for
Med
icare
cove
red
serv
ices.
Co-i
nsur
ance
may
appl
y.
19
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Lim
ited
to 2
5 ho
me h
ealth
visit
s fro
m Ju
ly 1
to
June
30
each
year
. The
Div
ision
of M
edica
id p
ays
for a
ll m
edica
lly n
eces
sary
serv
ices f
or
EPS
DT
-elig
ible
bene
ficia
ries i
n ac
cord
ance
with
Pa
rt 22
3 of
Titl
e 23,
with
out r
egar
d to
serv
ice
limita
tions
and
with
prio
r aut
horiz
atio
n.
Co-i
nsur
ance
may
appl
y.
$0 C
o-pa
y W
hat Y
ou S
houl
d K
now:
C
over
ed se
rvice
s inc
lude
par
t-tim
e or i
nter
mitt
ent
Skill
ed N
ursin
g an
d ho
me h
ealth
-aid
e ser
vice
s in
cludi
ng p
hysic
al th
erap
y, o
ccup
atio
nal t
hera
py,
and
spee
ch th
erap
y, m
edica
l and
socia
l ser
vice
s,
med
ical e
quip
men
t & su
pplie
s.
Hom
e Hea
lth C
are
12
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
Wha
t You
Sho
uld
Kno
w:
You
pay
noth
ing
for h
ospi
ce ca
re fr
om a
M
edica
re-c
ertif
ied
hosp
ice. Y
ou m
ay h
ave t
o pa
y pa
rt of
the c
ost f
or d
rugs
and
resp
ite ca
re. H
ospi
ce
is co
vere
d ou
tside
of o
ur p
lan. P
lease
cont
act u
s fo
r mor
e det
ails.
Hos
pice
Out
patie
nt S
ubst
ance
Abu
se1
23
$0 C
o-pa
y In
divi
dual
The
rapy
$0
Co-
pay
Gro
up T
hera
py
20
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
$0 C
o-pa
y R
enal
Dia
lysis
23
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Med
icaid
cove
rs ce
rtain
ove
r-th
e-co
unte
r (O
TC
) dr
ugs p
ursu
ant t
o a w
ritte
n/ve
rbal/
elect
roni
c pr
escr
iptio
n. O
TC
pre
scrip
tions
are i
nclu
ded
in
the m
onth
ly p
resc
riptio
n dr
ug b
enef
it lim
it bu
t all
coun
t as g
ener
ics.
The
Div
ision
of M
edica
id p
ays f
or al
l med
ically
ne
cess
ary
serv
ices f
or E
PSD
T-e
ligib
le
bene
ficia
ries i
n ac
cord
ance
with
Par
t 223
of T
itle
23, w
ithou
t reg
ard
to se
rvice
lim
itatio
ns an
d wi
th
prio
r aut
horiz
atio
n.
Co-i
nsur
ance
may
appl
y.
Our
plan
will
pay
up
to $
110
ever
y qua
rter
for
the p
urch
ase o
f cov
ered
ove
r-th
e-co
unte
r ite
ms.
Plea
se vi
sit o
ur w
ebsit
e to
see o
ur li
st of
cove
red
ov
er-t
he-c
ount
er it
ems.
Ove
r-th
e-C
ount
er (O
TC
) Hea
lth It
ems
$0 C
o-pa
y fo
r up
to 1
2 vi
sits p
er ye
ar
In-H
ome S
uppo
rt S
ervi
ces
12
3
Wha
t You
Sho
uld
Kno
w:
Mem
bers
who
mee
t clin
ical c
riter
ia h
ave a
cces
s to
In-H
ome S
uppo
rt se
rvice
s inc
ludi
ng li
ght
clean
ing,
hou
seho
ld ch
ores
, and
mea
l pre
para
tion.
Fo
r dua
l-elig
ible
mem
bers
, Med
icaid
pay
s co
-insu
ranc
e, co
-pay
men
ts an
d de
duct
ibles
for
Med
icare
cove
red
serv
ices.
Co-i
nsur
ance
may
appl
y.
M
eals
12
3
$0
Co-
pay
for p
ost-
acut
e mea
ls im
med
iate
ly
follo
wing
an In
patie
nt h
ospi
tal s
tay
to ai
d in
re
cove
ry w
ith a
max
of 1
0 m
eals
with
in 1
4 da
y
bene
fit d
urat
ion.
Post-
Acu
te M
eals
Chr
onic
Mea
ls
21
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
$0 C
o-pa
y fo
r chr
onic
mea
ls as
par
t of a
su
perv
ised
prog
ram
des
igne
d to
tran
sitio
n
mem
bers
with
chro
nic c
ondi
tions
with
a m
ax o
f 84
mea
ls pe
r yea
r, bu
t not
lim
ited
to n
umbe
r of
days
. Fo
r dua
l-elig
ible
mem
bers
, Med
icaid
pay
s co
-insu
ranc
e, co
-pay
men
ts an
d de
duct
ibles
for
Med
icare
cove
red
serv
ices.
$3 co
-pay
for M
edica
id-c
over
ed se
rvice
s.
You
pay
noth
ing
for M
edica
re co
vere
d se
rvice
s Fe
dera
l Qua
lifie
d H
ealth
Cen
ter S
ervi
ces
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
The
Div
ision
of M
edica
id p
ays f
or al
l med
ically
ne
cess
ary
serv
ices f
or E
PSD
T-e
ligib
le
bene
ficia
ries i
n ac
cord
ance
with
Par
t 223
of T
itle
23, w
ithou
t reg
ard
to se
rvice
lim
itatio
ns an
d wi
th
prio
r aut
horiz
atio
n.
Co-i
nsur
ance
may
appl
y.
Not
Cov
ered
Pr
ivat
e Dut
y Nur
sing
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Co-i
nsur
ance
may
appl
y.
You
pay
noth
ing
for M
edica
re co
vere
d se
rvice
s Fa
mily
Pla
nnin
g3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r Yo
u pa
y no
thin
g fo
r Med
icare
cove
red
serv
ices
Rur
al H
ealth
Clin
ic S
ervi
ces
3
Med
icare
cove
red
serv
ices.
$3 co
-pay
for M
edica
id-c
over
ed se
rvice
s.
22
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s.
Co-i
nsur
ance
may
appl
y.
Offe
red
by th
e plan
if y
ou m
eet q
ualif
icatio
ns
Tar
gete
d C
ase M
anag
emen
t3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s A
bdom
inal
Aor
tic A
neur
ysm
Scr
eeni
ng3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s A
lcoh
ol M
isuse
Scr
eeni
ng &
Cou
nsel
ing
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s Br
east
Pro
sthe
ses
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s C
ardi
ovas
cula
rDise
ase
(Beh
avio
ral T
hera
py)
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s D
epre
ssio
n Sc
reen
ing
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s D
iabe
tes S
elf-
Man
agem
ent T
rain
ing
3
23
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s H
IV S
cree
ning
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s M
acul
ar D
egen
erat
ion
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s O
besit
y Scr
eeni
ng an
d C
ouns
elin
g3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s O
stom
y Sup
plie
s3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s O
xyge
n T
hera
py3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s Pa
rtia
l Hos
pita
lizat
ion
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s Pn
eum
ococ
cal S
hot
3
24
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s Pr
osta
te C
ance
r Scr
eeni
ngs
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s R
adia
tion
The
rapy
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s R
elig
ious
Non
med
ical
Hea
lth C
are I
nstit
utio
n 3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s Se
cond
Sur
gica
l Opi
nion
s3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s Se
xual
ly T
rans
mitt
ed In
fect
ions
Scr
eeni
ng &
Cou
nsel
ing
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s Su
rgic
al D
ress
ing
Serv
ices
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s T
obac
co U
se C
essa
tion
Cou
nsel
ing
3
25
Miss
issip
pi D
ivisi
on o
f Med
icai
d W
ellC
are L
iber
ty (H
MO
SN
P)
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s T
eleh
ealth
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
You
pay
not
hing
for M
edica
re co
vere
d se
rvice
s T
rans
plan
ts an
d Im
mun
osup
pres
sive D
rugs
3
For d
ual-e
ligib
le m
embe
rs, M
edica
id p
ays
co-in
sura
nce,
co-p
aym
ents
and
dedu
ctib
les fo
r M
edica
re co
vere
d se
rvice
s. Co
-ins
uran
ce m
ay ap
ply.
Not
Cov
ered
T
rave
l Out
-of-
US
3
26
Well
Car
e Hea
lth P
lans,
Inc.,
is an
HM
O, P
PO, P
DP,
PFF
S pl
an w
ith a
Med
icare
cont
ract
and
is an
appr
oved
Par
t D S
pons
or. O
ur D
-SN
Ps h
ave c
ontra
cts
with
Sta
te M
edica
id p
rogr
ams.
Enr
ollm
ent i
n W
ellC
are L
iber
ty (H
MO
SN
P) d
epen
ds o
n co
ntra
ct re
newa
l. T
his i
nfor
mat
ion
is no
t a co
mpl
ete d
escr
iptio
n
of b
enef
its. C
all 1
-855
-292
-023
7 / T
TY
711
for m
ore i
nfor
mat
ion.
Li
mita
tions
, co-
paym
ents
and
restr
ictio
ns m
ay ap
ply.
Ben
efits
, pre
miu
ms a
nd/o
r co-
paym
ents/
coin
sura
nce m
ay ch
ange
on
Janu
ary
1 of
each
yea
r. T
he
form
ular
y, p
harm
acy
netw
ork
and/
or p
rovi
der n
etwo
rk m
ay ch
ange
at an
y tim
e. Yo
u wi
ll re
ceiv
e not
ice w
hen
nece
ssar
y.
You
mus
t con
tinue
to p
ay y
our M
edica
re P
art B
pre
miu
m. I
f you
mee
t cer
tain
elig
ibili
ty re
quire
men
ts fo
r bot
h M
edica
re an
d M
edica
id, y
our P
art B
pr
emiu
ms m
ay b
e cov
ered
in fu
ll. O
ur p
lans u
se a
form
ular
y. Y
ou h
ave t
he ch
oice
to si
gn u
p fo
r aut
omat
ed m
ail s
ervi
ce d
elive
ry. Y
ou ca
n ge
t pre
scrip
tion
dr
ugs s
hipp
ed to
your
hom
e thr
ough
our
net
work
mai
l ser
vice
deli
very
pro
gram
. You
shou
ld ex
pect
to re
ceiv
e you
r pre
scrip
tion
drug
s with
in 1
0–14
calen
dar
days
from
the t
ime t
hat t
he m
ail s
ervi
ce p
harm
acy
rece
ives
the o
rder
. If y
ou d
o no
t rec
eive
you
r pre
scrip
tion
drug
s with
in th
is tim
e, pl
ease
cont
act u
s at
1-86
6-89
2-90
06 (T
TY
1-86
6-50
7-61
35),
24 h
ours
a da
y, se
ven
days
a we
ek, o
r visi
t mai
lrx.w
ellca
re.co
m. P
lease
cont
act y
our p
lan fo
r det
ails.
27
Multi-Language Insert Multi-language Interpreter Services
ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-877-374-4056 (TTY: 711).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-374-4056 (TTY: 711).
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-877-374-4056 (TTY: 711) 。
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ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-877-374-4056 (телетайп: 711).
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-877-374-4056 (TTY: 711).
Multi-Language InsertMulti-Language Interpreter Services
ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-877-374-4056 (TTY: 711).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-374-4056 (TTY: 711).
WCM_14436Z Internal Approved 06132018 ©WellCare 2018 NA9WCMINS14436Z_0000
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-877-374-4056 (TTY: 711).
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-877-374-4056 (TTY: 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-877-374-4056 (TTY: 711).
注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-877-374-4056 (TTY: 711) まで、お電話にてご連絡ください。
ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք 1-877-374-4056 (TTY (հեռատիպ)՝ 711):
Multi-Language InsertMulti-Language Interpreter Services
ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-877-374-4056 (TTY: 711).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-374-4056 (TTY: 711).
WCM_14436Z Internal Approved 06132018 ©WellCare 2018 NA9WCMINS14436Z_0000
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-877-374-4056 (TTY: 711).
WCM_14436Z Internal Approved 06132018 NA7WCMINS02310E_0000 ©WellCare 2018
Discrimination is Against the Law WellCare Health Plans, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. WellCare Health Plans does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. WellCare Health Plans, Inc.:
Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats)
Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages
If you need these services, contact WellCare Customer Service for help or you can ask Customer Service to put you in touch with a Civil Rights Coordinator who works for WellCare. If you believe that WellCare Health Plans, Inc., has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: WellCare Health Plans, Inc. Grievance Department P.O. Box 31384 Tampa, FL 33631-3384 Telephone: 1-866-530-9491 TTY: 711 Fax: 1-866-388-1769 Email: [email protected] You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, a WellCare Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue SW. Room 509F, HHH Building Washington, DC 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. * This Nondiscrimination Notice also applies to all subsidiaries of WellCare Health Plans, Inc.
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Pre-Enrollment Checklist Before making an enrollment decision, it is important that you fully understand our benefits and rules. If you have any questions, you can call and speak to a customer service representative at 1-866-527-0056 (TTY 711).
Understanding the Benefits
Review the full list of benefits found in the Evidence of Coverage (EOC), especially for those services that you routinely see a doctor. Visit www.wellcare.com/medicare or www.ohanahealthplan.com/medicare or call 1-866-527-0056 to view a copy of the EOC.
Review the provider directory (or ask your doctor) to make sure the doctors you see now are in the network. If they are not listed, it means you will likely have to select a new doctor.
Review the pharmacy directory to make sure the pharmacy you use for any prescription medicines is in the network. If the pharmacy is not listed, you will likely have to select a new pharmacy for your prescriptions.
Understanding Important Rules
In addition to your monthly plan premium, you must continue to pay your Medicare Part B premium. This premium is normally taken out of your Social Security check each month.
Benefits, premiums and/or copayments/co-insurance may change on January 1, 2020.
Except in emergency or urgent situations, we do not cover services by out-of-network providers (doctors who are not listed in the provider directory).
This plan is a dual eligible special needs plan (D-SNP). Your ability to enroll will be based on verification that you are entitled to both Medicare and medical assistance from a state plan under Medicaid.
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Contact Us
For more information, please call us at the phone number below or visit us at www.wellcare.com/medicare.
Not yet a member? Please call us toll-free at 1-866-527-0056 (TTY 711). Your call may be answered by a licensed agent. Already a member? Please call us toll-free at 1-855-292-0237 (TTY 711).
Hours of Operation Between October 1 and March 31, representatives are available Monday–Sunday, 8 a.m. to 8 p.m. Between April 1 and September 30, representatives are available Monday–Friday, 8 a.m. to 8 p.m.
Formularies and Directories You can see our plan's Provider/Pharmacy Directory and our complete plan formulary (list of Part D prescription drugs) at our website: www.wellcare.com/medicare. Or, call us and we'll send you a copy. We're with our members every step of the way.
