24-1237m Important 2025 Medicare and Medicare DSNP Plan Changes
Date: 11/27/24
Updates include new plan codes, plan name change, a new vision vendor and more
The information in this update provides an overview of the changes to Medicare plans and the Medicare Dual Special Needs Plan (DSNP) starting January 1, 2025, as well as information about the new vision vendor, Premier Eye Care.
A table listing the 2025 Medicare and Medicare DSNP plan codes with the associated plan name and service area is at the end of this update.
Updates to Wellcare Dual Liberty (HMO DSNP)
The following changes will be made to the Wellcare Dual Liberty (HMO DSNP) plan for 2025:
2025 H contract & PBP1 | Plan name | New counties added |
|---|---|---|
H3561-001 | Wellcare Dual Liberty | Calaveras, Tuolumne |
|
| No longer sell DSNP plans to these counties |
H3561-001 | Wellcare Dual Liberty | Kern, Placer, San Francisco |
1 PBP = Plan Benefit Package
Note: Existing members will be able to stay in the plan for H3561-001 in Kern, Placer and San Francisco counties.
New plan and updates
New plan offering:
2025 H contract & PBP | Plan name | Service area |
|---|---|---|
H0562-133 | Wellcare Low Premium (HMO) | Amador, San Mateo, Santa Clara, Solano, Yolo |
Plan name changes:
- Wellcare No Premium Focus (HMO) plan name changes to Wellcare Simple Focus (HMO).
- Wellcare No Premium Ruby (HM) plan name changes to Wellcare Simple Ruby (HMO)
2025 H contract & PBP | New plan name | Service area |
|---|---|---|
H0562-012 | Wellcare Simple Focus (HMO) | Imperial, San Diego |
H0562-079 | Wellcare Simple Ruby (HMO) | Fresno, Kern, Madera, Stanislaus, Tulare |
H0562-097 | Wellcare Simple Focus (HMO) | San Francisco |
H0562-125 | Wellcare Simple Focus (HMO) | Los Angeles, Orange |
H0562-126 | Wellcare Simple Focus (HMO) | Riverside, San Bernardino |
Plans that changed PBPs:
2024 H contract & PBP | 2025 H contract & PBP | Plan name | Service area |
|---|---|---|---|
H0562-130-001 | H0562-136 | Wellcare Low Premium (HMO) | San Francisco |
H0562-002 | H0562-137 | Wellcare Low Premium (HMO) | Los Angeles, Orange |
Non-renewed plans ending December 31, 2024:
The following plans are not renewing for 2025. Members have received a non-renewal notice with their options on how to access their Medicare benefits.
H contract & PBP | Plan name | Service area |
|---|---|---|
H0562-128 | Wellcare No Premium (HMO) | Amador, San Mateo, Santa Clara, Solano, Yolo |
H7360 – all | Wellcare No Premium Open (PPO) | Amador, Sutter |
New vision vendor
Premier Eye Care is replacing Envolve Vision effective January 1, 2025. Medicare members with additional supplemental benefits will need to access Premier Eye Care for the covered services. Providers should refer to the member's Evidence of Coverage (EOC) to confirm specific coverage information exclusions, limitations and cost-sharing.
Contact Premier Eye Care from Monday through Friday, 8 a.m. – 8 p.m. Pacific time:
- Phone: 833-883-2339
- Email for questions or inquiries.
Access the 2025 Medicare Supplemental Vendor Contact Information list for more information.
Member renewal and non-renewal notices
- September 2024: Renewal notices, or Annual Notice of Change, for continuing plans were sent to members.
- October 2024: Non-renewal notices were sent to members.
New ID cards for all members
All enrolled members will receive a new 2025 health plan identification card by December 31, 2024.
Updated CMS special election periods (SEPs) for dual eligible beneficiaries
- The quarterly SEP for dually eligible beneficiaries will be discontinued in 2025.
- Starting January 1, 2025, Medicare will allow dually eligible members to switch to Original Medicare with a stand-alone prescription drug plan once per month.
- A new type of SEP for integrated care will allow dually eligible members to choose an applicable integrated plan (AIP) once per month, in any month of the year.
- Wellcare By Health Net offers these plans in Los Angeles, Sacramento, Tulare, Fresno, Kings, and Madera counties.
- Dually eligible members will not be able to enroll in, or change, Medicare Advantage plans or other Special Needs Plans outside of the usual times, except if a different SEP applies, such as moving to a different county.
DSNP resources for providers
An online provider resource for DSNP is available on our website at D-SNP Resources for Providers and serves as a guide to physicians and other providers. This site covers topics that include trainings and webinars, communications and more. Note that the FAQs for 2025 are being updated and will be available soon.
2025 Medicare and Medicare DSNP Plan Codes with Plan Name and Service Area
The table below shows the 2025 Wellcare By Health Net Medicare and Medicare DSNP1 plans and service areas:
2025 H contract & PBP2 | 2025 Plan name | Service area | 2025 Plan codes |
|---|---|---|---|
H0562-009 | Wellcare Premium Ultra (HMO) | Amador, Placer, Sacramento, | ME0 |
H0562-012 | Wellcare Simple Focus (HMO) | Imperial, San Diego | ME1 |
H0562-039 | Wellcare Premium Ultra (HMO) | Yolo | ME2 |
H0562-079 | Wellcare No Premium Ruby (HMO) | Fresno, Kern, Madera, Stanislaus, Tulare | ME3 |
H0562-092 | Wellcare Specialty No Premium (HMO C-SNP3) | Kern, Los Angeles, Orange, Riverside, | ME4 |
H0562-097 | Wellcare Simple Focus (HMO) | San Francisco | ME5 |
H0562-125 | Wellcare Simple Focus (HMO) | Los Angeles, Orange | ME6 |
H0562-126 | Wellcare Simple Focus (HMO) | Riverside, San Bernardino | ME7 |
H0562-133 | Wellcare Low Premium (HMO) | Amador, San Mateo, Santa Clara, Solano, Yolo | MEF |
H0562-136 | Wellcare Low Premium (HMO) | Los Angeles, Orange | MEG |
H0562-137 | Wellcare Low Premium (HMO) | Imperial, Riverside, San Bernardino, | MEH |
H3561-001 | Wellcare Dual Liberty (HMO D-SNP) | Amador, Calaveras, Imperial, Kern, | ME8 |
H3561-007 | Wellcare CalViva Health Dual Align (HMO D-SNP) | Fresno, Kings, Madera | ME9 |
H3561-008 | Wellcare Dual Align (HMO D-SNP) | Los Angeles, Sacramento, Tulare | MEB |
H3561-009 | Wellcare Dual Liberty (HMO D-SNP) | Orange, Riverside, San Bernardino, | MEC |
1DSNP – Dual Eligible Special Needs Plan
2PBP – Plan Benefit Package
3C-SNP – Chronic Condition Special Needs Plan
Additional information
Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on the provider portal.
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact the Provider Services Center
at 800-929-9224. Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.