- Participating Physician Groups (PPG)
Wellcare by Health Net offers the following plan types.
Preferred Provider Organization (PPO) Plans
PPO plans offer a wide network of doctors, specialists, and hospitals. Members do not need to choose a Primary Care Physician (PCP) and do not need a referral to see a specialist. Wellcare by Health Net PPO plans come with valuable extras, such dental, vision, hearing, fitness and more.
Health Maintenance Organization (HMO) Plans
Medicare Advantage HMO plans offer access to our wide network of doctors and hospitals, alongside more benefits than original Medicare. With an HMO plan, members have cost-savings by receiving most of their care and services from providers in the plan’s network. Members can expect to choose a Primary Care Physician, or PCP.
Wellcare by Health Net has multiple HMO plan options that provide access to important care. Our HMO plans come with valuable extras, such as dental, vision, hearing, fitness and more.
Special Needs Plans (SNP)
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
Dual Special Needs Plans (D-SNP)
Dual Special Needs plans (D-SNP) are a special type of Medicare Advantage plan designed to support individuals that also qualify for Medicaid coverage.
- Qualified Medicare Beneficiary Plus (QMB+): Helps pay Medicare Part A and Part B premiums, and other cost-sharing (like deductibles, coinsurance, and copayments). Some, people with QMB+ are also eligible for full Medicaid benefits.
- Specified Low-Income Medicare Beneficiary Plus (SLMB+): Helps pay Part B premiums. Some, people with SLMB+ are also eligible for full Medicaid benefits.
- Full Benefit Dual Eligible (FBDE): Helps pay Medicare Part A and Part B premiums and other cost-sharing (like deductibles, coinsurance, and co-payments). Eligible beneficiaries also receive full Medicaid benefits.
These plans offer all the coverage of original Medicare plus extra benefits for qualifying members at no cost. Members can get extra benefits like funds for over-the-counter healthcare items (vitamins, toothpaste and more), meal delivery, rides to doctor appointments, pharmacy, and so much more.
Exclusively Aligned Enrollment (EAE) D-SNP Program
Exclusively aligned enrollment (EAE) D-SNPs offer an integrated approach to care and care coordination and are only available in select counties in California.
Enrollment into the EAE D-SNP will result in the member's Medi-Cal plan changing to the same parent organization's Medi-Cal managed care plan. This matching is done by the state of California Department of Health Care Services (DHCS).
The matching EAE D-SNP and Medi-Cal plans will work together to deliver all covered benefits to their members including coordination with Medi-Cal fee-for-service providers.
Chronic Condition Special Needs (C-SNP) plans
Chronic Condition Special Needs (C-SNP) plans take a proactive approach to help manage chronic conditions like diabetes, cardiovascular disease or congestive heart failure. Wellcare by Health Net C-SNP plans are designed to provide cost savings on key medical necessities, like insulin, alongside coordinated care to help manage and reduce potential health risks associated with these conditions.
MEDICARE SUPPLEMENT PLAN
Medicare Supplement plans are identified by the letters A through N. These plans must follow federal and state laws and can only be utilized through a private health plan. The plan offers the following Medicare Supplement plans:
- Individual Medicare Supplement Plans - Health Net Life Insurance Company offers individual plans A, C, F, High Deductible F, G, K, L, and M.
- Employer Group Retiree Medicare Supplement Plans - Health Net Life Insurance Company offers plans A, B, C, D, F, High Deductible F, G, K, L, and M. Membership in a Health Net employer group is required in order to be eligible for these plans.
Health Net Life Insurance Company Medicare Supplement Optional Supplemental Packages
Health Net Life Insurance Company offers supplemental benefits for an additional monthly premium with individual Medicare Supplement plans.
- Optional Package #1 - Hearing care, Standard PPO Dental and PPO Vision
- Optional Package #2 - Hearing care, Enhanced PPO Dental and PPO Vision