WellCare Dividend (HMO) H1416-039-000 is a 2021 Medicare Advantage plan with drug coverage provided by WellCare.

In terms of networks, this plan is a Local HMO. HMO plans require you to choose an in-network primary care doctor who coordinates your care with other healthcare providers in your network. With HMOs, you must generally seek care in-network. If you seek care outside of the plan’s network, the plan will only cover emergency or urgent care in most cases. Local HMOs cover only a small service area or part of the country. If you want to have costs covered out of network, you may want to look for PPOs in your county. Meanwhile, if you need a wider area of coverage, you may want to look at Regional PPO plans specifically.

When it comes to cost-sharing, you’ll want to consider both monthly costs and out-of-pocket costs. This plan has a monthly premium of $0.00, which covers both the health and drug portions of the plan.

Since this plan has a zero-dollar Premium, you can enroll at no monthly cost. Please keep in mind zero-Premium Medicare plans typically have more out-of-pocket costs than higher Premium plans. So, if you tend to spend a lot out-of-pocket in a year, make sure to check out other plans as well.

The drug plan portion of this plan provides Enhanced Alternative (EA) benefits, which are benefits that exceed the required standard.

When it comes to out-of-pocket costs for drugs, this plan has a Part D drug Deductible of $0.00 and an Initial Coverage Limit of $4130. Each drug tier may be subject to different cost-sharing in each coverage phase, so keep that in mind when considering out-of-pocket costs. Check out the drug formulary below for more information, or reach out to a licensed Medicare agent for help using the call number on this page. Alternatively, if you know what plan you want, you can enroll online yourself using our site as well.


Plan Basics
Contract Year 2021
Medicare Type Medicare Advantage Plan (Part C)
CMS Plan ID H1416-039-000
Plan Organization WellCare
Plan Type Local HMO
Plan Name WellCare Dividend (HMO)
Plan Organization Type Local CCP
Drugs Covered Yes
Doctors Choice Plan Doctors for Most Services
Benefit Type Enhanced Alternative
Special Needs Plan No
Overall Star Rating 3
Plan Cost Sharing
Premium $0.00
Total Premium (Includes Part B) $85.50
Monthly Part C Premium $0.00
Monthly Part D Basic Premium $0.00
Monthly Part D Supplemental Premium $0.00
Monthly Part D Total Premium $0.00
Monthly Part D Premium Full Assistance $0.00
Monthly Part D Premium 75% Assistance $0.00
Monthly Part D Premium 50% Assistance $0.00
Monthly Part D Premium 25% Assistance $0.00
Part D Drug Deductible $0.00
Part D Initial Coverage Limit $4130.00
Part D Catastrophic Coverage Threshold $6550.00
Maximum Out-of-Pocket Limit for Parts A & B (MOOP) $6700.00
Gap Coverage No

Medicare Advantage Plan Health Benefits


Additional Benefits And/or Reduced Cost-sharing For Enrollees With Certain Health Conditions?
Service Cap Network Auth. Req. Ref. Req. Cost Share
- In-Network - - No
Comprehensive Dental
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diagnostic services Yes - Yes Yes $0 copay
Endodontics Yes - Yes Yes $0 copay
Extractions Yes - Yes Yes $0 copay
Non-routine services Yes - Yes Yes $0 copay
Periodontics Yes - Yes Yes $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services Yes - Yes Yes $0 copay
Restorative services Yes - Yes Yes $0 copay
Diagnostic Procedures/lab Services/imaging
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diagnostic radiology services (e.g., MRI) - - Yes No $0-350 copay
Diagnostic tests and procedures - - Yes No $0-20 copay
Lab services - - Yes No $0 copay
Outpatient x-rays - - Yes No $0 copay
Doctor Visits
Service Cap Network Auth. Req. Ref. Req. Cost Share
Primary - - - - $0 copay
Specialist - - Yes No $50 copay per visit
Emergency Care/Urgent Care
Service Cap Network Auth. Req. Ref. Req. Cost Share
Emergency - - - - $90 copay per visit (always covered)
Urgent care - - - - $35 copay per visit (always covered)
Foot Care (podiatry Services)
Service Cap Network Auth. Req. Ref. Req. Cost Share
Foot exams and treatment - - Yes No $50 copay
Routine foot care - - - - Not covered
Ground Ambulance
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $250 copay
Health Plan Deductible
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $0
Hearing
Service Cap Network Auth. Req. Ref. Req. Cost Share
Fitting/evaluation Yes - Yes Yes $0 copay
Hearing aids Yes - Yes Yes $0 copay
Hearing exam - - Yes Yes $50 copay
Inpatient Hospital Coverage
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - Yes No $375 per day for days 1 through 5$0 per day for days 6 through 90
Maximum Out-of-pocket Enrollee Responsibility (does Not Include Prescription Drugs)
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $6,700 In-network
Medical Equipment/supplies
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diabetes supplies - - Yes - 20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) - - Yes - 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) - - Yes - 20% coinsurance per item
Medicare Part B Drugs
Service Cap Network Auth. Req. Ref. Req. Cost Share
Chemotherapy - - Yes - 20% coinsurance
Other Part B drugs - - Yes - 20% coinsurance
Mental Health Services
Service Cap Network Auth. Req. Ref. Req. Cost Share
Inpatient hospital - psychiatric - - Yes No $1,600 per stay
Outpatient group therapy visit - - Yes No $40 copay
Outpatient group therapy visit with a psychiatrist - - Yes No $40 copay
Outpatient individual therapy visit - - Yes No $40 copay
Outpatient individual therapy visit with a psychiatrist - - Yes No $40 copay
Optional Supplemental Benefits
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - No
Other Health Plan Deductibles?
Service Cap Network Auth. Req. Ref. Req. Cost Share
- In-Network - - No
Outpatient Hospital Coverage
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - Yes No $350 copay per visit
Preventive Care
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - No No $0 copay
Preventive Dental
Service Cap Network Auth. Req. Ref. Req. Cost Share
Cleaning Yes - Yes Yes $0 copay
Dental x-ray(s) Yes - Yes Yes $0 copay
Fluoride treatment Yes - Yes Yes $0 copay
Oral exam Yes - Yes Yes $0 copay
Rehabilitation Services
Service Cap Network Auth. Req. Ref. Req. Cost Share
Occupational therapy visit - - Yes No $40 copay
Physical therapy and speech and language therapy visit - - Yes No $40 copay
Skilled Nursing Facility
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - Yes No $0 per day for days 1 through 20$165 per day for days 21 through 100
Transportation
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - Not covered
Vision
Service Cap Network Auth. Req. Ref. Req. Cost Share
Contact lenses Yes - Yes Yes $0 copay
Eyeglass frames Yes - Yes Yes $0 copay
Eyeglass lenses Yes - Yes Yes $0 copay
Eyeglasses (frames and lenses) Yes - Yes Yes $0 copay
Other No - - - Not covered
Routine eye exam Yes - Yes Yes $0 copay
Upgrades Yes - Yes Yes $0 copay
Wellness Programs (e.g., Fitness, Nursing Hotline)
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - No No Covered
Plan Drug Info
Formulary Link Drug Formulary Directory
Official Medicare Contact
Medicare Phone 1-800-MEDICARE (1-800-633-4227)
Medicare TTY User 1-877-486-2048
Plan Available in these Counties
Anderson County, Tennessee, Bedford County, Tennessee, Benton County, Tennessee, Bledsoe County, Tennessee, Blount County, Tennessee, Bradley County, Tennessee, Campbell County, Tennessee, Cannon County, Tennessee, Carroll County, Tennessee, Carter County, Tennessee, Cheatham County, Tennessee, Chester County, Tennessee, Claiborne County, Tennessee, Clay County, Tennessee, Cocke County, Tennessee, Coffee County, Tennessee, Crockett County, Tennessee, Cumberland County, Tennessee, Davidson County, Tennessee, Decatur County, Tennessee, Dekalb County, Tennessee, Dickson County, Tennessee, Dyer County, Tennessee, Fayette County, Tennessee, Fentress County, Tennessee, Franklin County, Tennessee, Gibson County, Tennessee, Giles County, Tennessee, Grainger County, Tennessee, Greene County, Tennessee, Grundy County, Tennessee, Hamblen County, Tennessee, Hamilton County, Tennessee, Hancock County, Tennessee, Hardeman County, Tennessee, Hardin County, Tennessee, Hawkins County, Tennessee, Haywood County, Tennessee, Henderson County, Tennessee, Henry County, Tennessee, Hickman County, Tennessee, Houston County, Tennessee, Humphreys County, Tennessee, Jackson County, Tennessee, Jefferson County, Tennessee, Johnson County, Tennessee, Knox County, Tennessee, Lake County, Tennessee, Lauderdale County, Tennessee, Lawrence County, Tennessee, Lewis County, Tennessee, Lincoln County, Tennessee, Loudon County, Tennessee, Macon County, Tennessee, Madison County, Tennessee, Marion County, Tennessee, Marshall County, Tennessee, Maury County, Tennessee, Mcminn County, Tennessee, Mcnairy County, Tennessee, Meigs County, Tennessee, Monroe County, Tennessee, Montgomery County, Tennessee, Moore County, Tennessee, Morgan County, Tennessee, Obion County, Tennessee, Overton County, Tennessee, Perry County, Tennessee, Pickett County, Tennessee, Polk County, Tennessee, Putnam County, Tennessee, Rhea County, Tennessee, Roane County, Tennessee, Robertson County, Tennessee, Rutherford County, Tennessee, Scott County, Tennessee, Sequatchie County, Tennessee, Sevier County, Tennessee, Shelby County, Tennessee, Smith County, Tennessee, Stewart County, Tennessee, Sullivan County, Tennessee, Sumner County, Tennessee, Tipton County, Tennessee, Trousdale County, Tennessee, Unicoi County, Tennessee, Union County, Tennessee, Van Buren County, Tennessee, Warren County, Tennessee, Washington County, Tennessee, Wayne County, Tennessee, Weakley County, Tennessee, White County, Tennessee, Williamson County, Tennessee, Wilson County, Tennessee

NOTE: Information on MedicarePolicyHelper.com is for educational purposes only. We are not affiliated with Medicare, or CMS. Medicare has not reviewed or endorsed the information on our site. All plan data on our site comes directly from medicare.gov and is subject to change.