MEDICARE MEMBERS: PROTECT YOURSELF AGAINST MEDICARE FRAUD AND IDENTIFY THEFT! THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. LEARN HOW TO PROTECT YOURSELF.
Plan Benefit Materials |
Plan Materials and Forms
Information about plan benefits, services, and drug costs can be found in your plan materials.
You can also look for plan materials based on the plan name and the county you live in.
This booklet gives you a summary of costs and coverage in your plan.
Please select the document for your plan and county:
For HMO Members:
Plan Name |
CMS# |
County |
Summary of Benefits |
|---|---|---|---|
Wellcare No Premium (HMO) |
H6550-003 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
|
Wellcare Assist (HMO) |
H6550-006 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
|
Wellcare Giveback (HMO) |
H6550-007 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For HMO D-SNP Members:
Plan Name |
CMS# |
County |
Summary of Benefits |
|---|---|---|---|
Wellcare Dual Access (HMO D-SNP) |
H6550-004 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
|
Wellcare Dual Liberty (HMO D-SNP) |
H6550-009 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For PPO Members:
Plan Name |
CMS# |
County |
Summary of Benefits |
|---|---|---|---|
Wellcare No Premium Open (PPO) |
H9387-001 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
|
Wellcare Patriot Giveback Open (PPO) |
H9387-002 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For PPO D-SNP Members:
Plan Name |
CMS# |
County |
Summary of Benefits |
|---|---|---|---|
Wellcare Dual Access Open (PPO D-SNP) |
H9387-004 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
Summary of Benefits, H9387-004 - English (PDF) - Coming Soon |
This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.
Please select the document for your plan and county:
For HMO Members:
Plan Name |
CMS# |
County |
Evidence of Coverage |
|---|---|---|---|
Wellcare No Premium (HMO) |
H6550-003 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
Evidence of Coverage - English, H6550-003 - English (PDF)
|
Wellcare Assist (HMO) |
H6550-006 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
Evidence of Coverage - English, H6550-006 - English (PDF) Dental Benefit Details - English (PDF) - coming soon |
Wellcare Giveback (HMO) |
H6550-007 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
Evidence of Coverage - English, H6550-007 - English (PDF) Dental Benefit Details - English (PDF) - coming soon |
For HMO D-SNP Members:
Plan Name |
CMS# |
County |
Evidence of Coverage |
|---|---|---|---|
Wellcare Dual Access (HMO D-SNP) |
H6550-004 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
Evidence of Coverage, H6550-004 - English (PDF) Dental Benefit Details - English (PDF) - coming soon |
Wellcare Dual Liberty (HMO D-SNP) |
H6550-009 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
Evidence of Coverage, H6550-009 - English (PDF) Dental Benefit Details - English (PDF) - coming soon |
For PPO Members:
Plan Name |
CMS# |
County |
Evidence of Coverage |
|---|---|---|---|
Wellcare No Premium Open (PPO) |
H9387-001 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
Evidence of Coverage, H9387-001 - English (PDF) Dental Benefit Details - English (PDF) - coming soon |
Wellcare Patriot Giveback Open (PPO) |
H9387-002 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
Evidence of Coverage, H9387-002 - English (PDF) Dental Benefit Details - English (PDF) - coming soon |
For PPO D-SNP Members:
Plan Name |
CMS# |
County |
Evidence of Coverage |
|---|---|---|---|
Wellcare Dual Access Open (PPO D-SNP) |
H9387-004 |
Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
Evidence of Coverage, H9387-004 - English (PDF) Dental Benefit Details - English (PDF) - coming soon |
This booklet will tell you about changes to your plan’s costs and benefits for the coming year.
Please select the document for your plan and county:
For HMO Members:
| Plan Name | CMS# | County | Annual Notice of Change |
|---|---|---|---|
| Wellcare No Premium (HMO) | H6550-003 | AAllen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
| Wellcare Assist (HMO) | H6550-006 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
| Wellcare Giveback (HMO) | H6550-007 | AAllen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For HMO D-SNP Members:
| Plan Name | CMS# | County | Annual Notice of Change |
|---|---|---|---|
| Wellcare Dual Access (HMO D-SNP) | H6550-004 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
| Wellcare Dual Liberty (HMO D-SNP) | H6550- 009 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
For PPO and PPO D-SNPMembers:
| Plan Name | CMS# | County | Annual Notice of Change |
|---|---|---|---|
| Wellcare No Premium Open (PPO) | H9387-001 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
| Wellcare Patriot Giveback Open (PPO) | H9387-002 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte | |
| Wellcare Dual Access Open (PPO D-SNP) | H9387-004 | Allen, Anderson, Atchison, Bourbon, Brown, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Franklin, Geary, Greenwood, Harvey, Jackson, Jefferson, Johnson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Nemaha, Neosho, Osage, Pottawatomie, Reno, Riley, Saline, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson, Wyandotte |
- Medicare Step Therapy Part B (PDF)