Wellcare Patriot Giveback (HMO-POS) Medicare Advantage Plan H2491-030 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7900.00In-network
- Part B Giveback
- −$125.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 0 beneficiaries
Wellcare Patriot Giveback (HMO-POS) Introduction
This Medicare Advantage HMO-POS plan, Wellcare Patriot Giveback, is offered by Wellcare and uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $7900.00. The plan is identified by CMS Plan ID H2491-030.
Plan Benefits
Cost-sharing for Wellcare Patriot Giveback includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H2491-030.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay |
| Specialist | In-network: $40 copay | In-network: $35 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0-$40 copay | In-network: $0-$40 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$375 copay | In-network: $0-$350 copay |
| Lab services | In-network: $0-$50 copay | In-network: $0-$50 copay |
| Outpatient x-rays | In-network: $50 copay | In-network: $50 copay |
| Diagnostic tests and procedures | In-network: $0-$20 copay | In-network: $0-$40 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $115 copay | $115 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | $35 copay | $35 copay |
| Inpatient hospital care | In-network: Tier 1 $375 per day for days 1-7 $0 per day for days 8-90 $0 per stay |
In-network: Tier 1 $325 per day for days 1-8 $0 per day for days 9-90 $0 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-60 $0 per day for days 61-100 |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-60 $0 per day for days 61-100 |
| Ground ambulance | In-network: $350 copay | In-network: $275 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0 copay | In-network: $0 copay |
| Outpatient group therapy | In-network: $0 copay | In-network: $0 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $375 per day for days 1-7 $0 per day for days 8-90 $0 per stay |
In-network: Tier 1 $325 per day for days 1-8 $0 per day for days 9-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $40 copay | In-network: $40 copay |
| Occupational therapy | In-network: $35 copay | In-network: $35 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: $0 copay |
| Durable medical equipment | In-network: 20% coinsurance | In-network: 20% coinsurance |
| Prosthetics | In-network: 20% coinsurance | In-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Restorative services | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | In-network: $0 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay | In-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay | In-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | In-network: $0 copay | In-network: $0 copay |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | In-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay | In-network: $0 copay |
| Prescription hearing aids | In-network: $0 copay | In-network: $0 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | In-network: $0 copay | In-network: $0 copay |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by Wellcare Patriot Giveback as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: H2491)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Wellcare
- Website
- Wellcare Plan Page
- Providers
- Wellcare Providers Page
- Formulary
- Wellcare Formulary Page
- Pharmacy
- Wellcare Pharmacy Page
- New Member Health Plan Help
- (844)480-0680
- New Member Health Plan TTY
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Wellcare Patriot Giveback (H2491-030-0) is available in the following locations:
Louisiana Parishes Served
- Acadia
- Allen
- Ascension
- Assumption
- Avoyelles
- Cameron
- East Baton Rouge
- East Feliciana
- Evangeline
- Grant
- Iberia
- Iberville
- Jefferson
- Jefferson Davis
- La Salle
- Lafayette
- Lafourche
- Livingston
- Orleans
- Plaquemines
- Pointe Coupee
- Rapides
- Saint Bernard
- Saint Charles
- Saint Helena
- Saint James
- Saint Landry
- Saint Martin
- Saint Mary
- Saint Tammany
- St John The Baptist
- Vermilion
- Vernon
- Washington
- West Baton Rouge
- West Feliciana
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Wellcare Patriot Giveback (HMO-POS)
What is the monthly premium for Wellcare Patriot Giveback (HMO-POS)?
The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan H2491-030?
For 2027, the in-network maximum out-of-pocket is $7900.00. The plan pays 100% of covered in-network services beyond this amount.
What is the total enrollment for plan H2491-030?
Total enrollment is 0 beneficiaries based on the latest CMS data.
What is the Part D deductible for plan H2491-030?
The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Wellcare (official source) | http://www.wellcare.com/ohana | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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