Medicare Advantage additional benefits — 2021

Your WellFirst Health Medicare plan includes additional benefits not covered under Original Medicare (Medicare Parts A and B)

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Dental

WellFirst Health — provided by SSM Health Plan — has joined with Delta Dental of Wisconsin to provide you dental benefits with no waiting periods, deductibles, or coinsurance. 

Benefits include: 

  • Preventive and diagnostic services: $0 copay 
  • Gum disease maintenance and bridge/implants/dentures repairs: $45 copay. 
  • Fillings, gum disease treatment and extractions: $95 copay. 
  • Root canals, bridges, implants, dentures and crowns: $595 copay. 

Our plan will cover $1,500 of dental services per year.  See the Dental Certificate of Coverage for a full list of covered dental procedures. 

Your WellFirst Health dental coverage does not cover services performed by an out-of-network dentist.
Tell your dentist that you have dental coverage through your Medicare Advantage plan and a secondary carrier. Take your ID cards to your appointment. Your primary insurance (WellFirst Health) will process first and your secondary dental insurance will process second. Having dual coverage does not guarantee no out-of-pocket responsibilities.
There is no coinsurance for covered Preventive benefits. You will pay 20% - 50% coinsurance for covered Restorative and Comprehensive benefits. See your Evidence of Coverage for complete details for your plan.

In-home/virtual support & companionship

SSM Health Plan Companion and SSM Health Plan Harmony only 

WellFirst Health has partnered with Papa, a company that connects screened and trained Papa Pals with our members. 

Pals are matched to members based on shared interests and communication style. Papa Pals help members who seek companionship, house help, technology help and transportation. This includes: 

  • Companionship: Papa Pals can socialize, watch a movie, and play games in the member’s home, in a public space, over the phone, or by video chat. 
  • House help: Papa Pals help around the house with light cleaning, laundry, cooking/meal prep, and taking care of pets. 
  • Technology help: Papa Pals teach members how to use a computer, smart phone and tablet. Papa Pals can also assist with how to use social media, accessing a telehealth provider and starting a video chat with loved ones. 
  • Transportation: Papa Pals assist members with transportation to doctor appointments, grocery/pharmacy shopping and other errands. Pals will pick members up at their homes, take members to the store or appointment, carry shopping bags, take members back home and help carry your bags into the home. 

Papa Pals can support members either in their homes or virtually. Members are eligible for 10 hours per month of Papa services. Papa will call to enroll you in the Papa program. Members can also call Papa to enroll at 888-282-7665. 

Over-the-counter allowance 

We offer $60 per quarter for you to spend on useful over-the-counter supplies. You can use your OTC card to shop online at participating stores or over the phone, via the catalog or in-person. Participating stores include Walgreens, CVS and Walmart. See the flyer for more details. You will receive your OTC card in the mail. When you receive your card, call the activation number listed on the card. Your OTC card can be used to purchase items in the following categories: 

  • Acid controller liquids/tablets 
  • Adult aspirin & pain relief 
  • Allergy, sinus & combo liquids & tablets 
  • Cough, cold & flu liquids or tablets 
  • Digestive aids (probiotics & prebiotics) 
  • Heart health & essential fatty acids (fish oil, flax, GLA, etc.) 
  • Laxatives (stool softeners & fiber acid) 
  • Ear drops & eye wash 
  • Incontinence 
  • Vitamins & minerals 
  • Oral care

After you receive your OTC card, visit OTCNetwork.com to see the list of all participating retailers, a full list of covered items and to check your card balance. 

Silver&Fit

WellFirst Health members have access to Silver&Fit fitness program. This program offers no-cost fitness center memberships, online fitness tools and online classes. You can select one of two free options:

  • Fitness center membership: You can go to any Silver&Fit fitness club, YMCA, or exercise center* that takes part in the program, or
  • Home fitness program: You can choose from a variety of home fitness kits. You can get up to 2 kits each benefit year.

*Non-standard services that call for an added fee are not part of the Silver&Fit program and will not be reimbursed. The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit is a federally registered trademark of ASH.

Visit SilverandFit.com to register, log in or to find a fitness center.

Vision

All of our plans include a $0 routine vision exam and a $200 eyewear allowance every year at our in-network eyewear providers.  

Where can I buy eyeglasses?

Find a location.

Hearing

All of our plans include a $0 hearing exam and a $750 hearing aid allowance every year at in-network hearing aid providers. 

Where can I buy hearing aids? 

Find a location.

Living Healthy

We will reward members up to $150 for your healthy lifestyle. Here's how it works:

  • Choose the healthy activities you want to complete.
  • Each completed activity is worth reward points (example: 500 points = $50)
  • Earn up to 1,500 points for a maximum of $150 per calendar year (before Dec. 31, 2021)
  • Rewards come in the form of gift card(s) of your choice to many national retailers, restaurants and other popular merchants.

Members must enter and redeem all points by Dec. 31, 2021 to be eligible for rewards. For complete details and to redeem reward points, log in to the Living Healthy Portal.

Meals post-discharge

If you are discharged from the hospital or skilled nursing facility, all of our plans cover 14 meals delivered to your door. Once you have discussed dietary needs and preferences with Mom's Meals, these meals will arrive frozen and you can heat and eat them at your convenience. If you would like to coordinate meal benefits as part of your discharge planning, call the Customer Care Center at 877-301-3326. 

Transportation

We cover 24 one-way Lyft rides each year to medical appointments or to the local pharmacy to help keep you well. If you would like a Lyft ride to an upcoming appointment, call the Customer Care Center at 877-301-3326. They will give you a code so that you or your representative can schedule a Lyft driver to pick you up at no cost to you.

Learn about Lyft rides

Routine footcare

We cover 10 routine footcare visits every calendar year. This includes treatment of the foot which is generally considered preventive, i.e., cutting or removal of corns, warts, calluses or nails.

Nurse advice line 

Experienced registered nurses are always available to answer your questions and concerns. Nurses are available 24 hours a day, 365 days a year. If you're not sure you need to see a doctor—or you're wondering if you have a problem—give us a call 833-925-0398 

Virtual Visit

With an SSM Health Virtual Visit you can get a diagnosis, a treatment plan, and a prescription if needed for common conditions like upper respiratory infection or allergies, urinary tract infections, tick bites and skin problems from anywhere in Wisconsin at any time. See conditions treated and complete an online health interview. An SSM Health provider will respond within 1 hour during office hours, or first thing the next morning if after hours. Virtual Visits are available to members through age 80. To ensure members receive the highest quality of care, those age 81 and above should be seen at a clinic or doctor’s office. 

Start a Virtual Visit

View our Medicare disclaimers

H8019_wellfirstbenefits.com
Updated 10/12/20