Navigating The Ins And Outs Of Billing Wellpoint Insurance

Wellpoint Insurance Company (Wellpoint) and Wellpoint, Inc. (Wellpoint) offer Medicare Supplement Insurance Plans (also known as Medigap) in Arizona and Texas. These plans help to cover out-of-pocket costs that Original Medicare doesn't, such as deductibles, copays, and coinsurance. Wellpoint also offers Medicare Advantage insurance in New Jersey, which includes medical, hospital, dental, vision, hearing, and prescription benefits. Wellpoint's health plans are tailored for Group Insurance Commission (GIC) members in Massachusetts, providing healthcare benefits exclusively to this group. Wellpoint members can also take advantage of the Sydney Health App, which makes it easy to find doctors, access ID cards, and chat with live agents.

Medicare Supplement Plans (Medigap)

Medicare Supplement Insurance, also known as Medigap, is extra insurance you can buy from a private health insurance company. It helps cover your share of out-of-pocket costs in Original Medicare (Part A and Part B). Generally, you must have Original Medicare to buy a Medigap policy, and you get a 6-month open enrollment period to enroll, which is a one-time offer.

All Medigap policies are standardized, meaning policies with the same letter offer the same basic benefits, no matter the insurance company or location. There are 10 different types of plans offered in most states, named by letters: A-D, F, G, and K-N. The price is the only difference between plans with the same letter sold by different companies. In some states, you may be able to buy a Medigap policy called Medicare SELECT, which you can change to a standard Medigap policy within 12 months if you change your mind.

Medigap plans generally help cover your share of costs for services under Original Medicare. Each plan offers different benefits, allowing you to choose one that meets your needs. Some Medigap policies even cover services that Original Medicare does not, like emergency medical care during foreign travel. However, Medigap plans do not cover everything. They generally exclude long-term care, vision or dental care, and private-duty nursing. Additionally, Medigap plans sold after 2005 do not include prescription drug coverage, so you would need to enroll in a separate Medicare drug plan (Part D) for that.

When you have a Medigap policy and receive care, Medicare pays its share of the approved amount for covered health care costs. Your Medigap policy then pays your doctor what you owe under your policy, and you are responsible for any remaining costs. Medigap policies only cover one person, so each individual must purchase their own plan. These policies are automatically renewed annually as long as premiums are paid and can only be dropped under specific circumstances, such as non-payment of premiums or the insurance company going out of business.

Medicare Advantage Insurance Plans

When choosing a Medicare Advantage Plan, it is important to consider the provider network. In most cases, you will need to use doctors and providers within the plan's network, although some plans may offer out-of-network coverage at a higher cost. Additionally, you may need a referral to see a specialist, depending on the type of plan you choose.

Medicare Advantage Plans offer flexibility in terms of coverage. While most plans include drug coverage, some may choose not to offer it, in which case you can join a separate Medicare drug plan. It is worth noting that if you join an HMO plan that doesn't offer drug coverage, you won't be able to get a separate Medicare drug plan.

Wellpoint offers Medicare Advantage Insurance Plans in select states, including New Jersey. These plans provide comprehensive coverage and include medical, hospital, dental, vision, hearing, and prescription benefits.

Medicare Advantage Special Needs Plans

There are three types of Special Needs Plans:

Chronic Condition Special Needs Plans (C-SNPs)

C-SNPs offer special care for people with diabetes, cardiovascular disorders, chronic heart failure, chronic lung disorders, or other qualifying conditions. These plans are designed for people with severe or disabling long-term health problems.

Dual-Eligible Special Needs Plans (D-SNPs)

D-SNPs are for people who have both Medicare and Medicaid. These plans combine all Medicare and Medicaid benefits into one easy-to-manage plan. D-SNPs also provide extra benefits not provided by either Medicare or Medicaid, such as dental, vision, and hearing coverage, as well as support for OTC, utilities, groceries, and transportation.

Institutional Special Needs Plans (I-SNPs)

I-SNPs are for people who live in a care facility like a nursing home or receive nursing care at home. These plans are for individuals who have received or are expected to need, for 90 days or longer, the level of services provided in a long-term care skilled nursing facility, a long-term care nursing facility, or an intermediate care facility for those with intellectual disabilities.

To be eligible for a Special Needs Plan, an individual must meet the requirements for one of the three types of SNPs and live in the plan's service area. SNPs are either HMO or PPO plan types and may cover extra services tailored to the specific groups they serve. For example, a network dealing with congestive heart failure might provide programs to help people with that specific condition.

Medicare Extension Plans

Wellpoint's Medicare Extension is a Medicare supplemental plan available to GIC Medicare retirees. It is the choice of most GIC Medicare retirees due to the following reasons:

• Use any doctor or hospital in the U.S., even if you’re away from home.
• Use Medicare participating providers to ensure you receive the highest benefits.
• Medicare Extension covers some things Medicare doesn’t, like hearing aids and eye exams.
• Your prescription drug coverage through SilverScript eliminates the coverage gap.
• You have a $10 copay for office visits, urgent care centres and retail medical clinics. That’s lower than many Medicare plans available through the GIC.
• There’s no deductible, lifetime maximum, or limit on pre-existing conditions.

Medicare Advantage Plans (Part C) are another type of Medicare health plan generally offered by private companies that contract with Medicare. These plans can be changed under certain circumstances, such as moving out of a plan's service area or losing other coverage.

STAR+PLUS MMP (Medicare-Medicaid Plan)

Advantages of Joining STAR+PLUS MMP:

There are many advantages to joining this type of plan, including:

• Getting all of your covered Medicare and Medicaid services without paying extra to join the health plan.
• Having both an individual Service Coordinator and a service coordination team who will work with you and your care providers to come up with a Plan of Care specifically designed to meet your health needs. Your Service Coordinator will be responsible for coordinating the services you need, such as informing your doctors about the medicines you take and ensuring that your test results are shared with you.
• Additional benefits such as an allowance for Walmart over-the-counter items, dental care, eyeglasses or contacts, and hearing aids.

Eligibility Requirements:

To be eligible for the STAR+PLUS MMP plan, you must meet the following criteria:

• Be age 21 or older.
• Live in either Bexar, Dallas, or Hidalgo County.
• Have both Medicare Part A and Medicare Part B.
• Be a United States citizen or be lawfully present in the US.
• Be eligible for Medicaid and have a physical or mental disability, or qualify for Supplemental Security Income (SSI) or Home and Community-Based Services (HCBS) waiver services.
• You are not enrolled in certain 1915(c) waiver programs, such as Community Living Assistance and Support Services (CLASS) or Texas Home Living Program (TxHmL).

For more information on eligibility and enrollment, you can contact Member Services at 1-866-896-1844. Hours are 8 a.m. to 8 p.m., Monday through Friday. TTY users can call 711.

Frequently asked questions