Medicare Advantage plans

Medicare coverage – plus much more!

With Medicare Advantage plans from WellFirst Health — provided by SSM Health Plan — you'll find comprehensive Medicare coverage and access to quality care and a strong network of providers in a five-county service area in St. Louis City and the surrounding four-county service area: Madison and St. Clair counties in Illinois, and St. Charles and St. Louis counties in Missouri. You must live in the service area to enroll in a WellFirst Health Medicare Advantage plan. 

WellFirst Health Medicare Advantage plans include medical, comprehensive dental and prescription drug coverage options. All plans also have added benefits, such as over-the-counter item allowance, hearing, vision, transportation, meal allowance, gym membership and at-home fitness kits, chiropractic, nurse line and wellness rewards. 

WellFirst Health plan options and details

2021 benefit overview

Unity (HMO)

$
0
Monthly Premium
  • Part D coverage
    Yes
  • Out-of-network coverage
    No
  • In-home support services
    N/A
  • Part B premium reduction^
    $35
  • Primary care
    $0
  • Premium
    $0
  • Specialist
    $35
  • Urgent care
    $35 in- & out-of-network
  • Emergency room
    $120 in- & out-of-network
  • Ambulance
    $250
  • Hospital daily copay: 1-7 days
    $325 daily
  • Therapy: PT, OT & speech
    $35
  • Outpatient surgery
    $275 copay
  • Max out-of-pocket+
    In-network: $2,500

Companion (HMO)

$
0
Monthly Premium
  • Part D coverage
    Yes
  • Out-of-network coverage
    No
  • In-home support services
    10 hours/month
  • Part B premium reduction^
    N/A
  • Primary care
    $0
  • Specialist
    $35
  • Premium
    $0
  • Urgent care
    $35 in- & out-of-network
  • Emergency room
    $120 in- & out-of-network
  • Ambulance
    $250
  • Hospital daily copay: 1-7 days
    $325 daily
  • Therapy: PT, OT & speech
    $35
  • Outpatient surgery
    $275 copay
  • Max out-of-pocket+
    In-network: $2,500

Integrity (HMO-POS)

$
0
Monthly Premium
  • Part D Coverage
    Yes
  • Out-of-network coverage
    Yes
  • In-home support services
    N/A
  • Part B premium reduction^
    N/A
  • Primary care
    $0*/$30**
  • Specialist
    $35*/$60**
  • Premium
    $0
  • Urgent care
    $35 in- & out-of-network
  • Emergency room
    $120 in- & out-of-network
  • Ambulance
    $250*/40%**
  • Hospital daily copay: 1-7 days
    $325*/$500**
  • Therapy: PT, OT & speech
    $35*/$60**
  • Outpatient surgery
    $275*/20% **
  • Max out-of-pocket+
    In-network: $2,500; Combined in- & out-of-network: $5,000

Harmony (HMO-POS MA-only)

$
0
Monthly Premium
  • Part D coverage
    N/A
  • Out-of-network coverage
    Yes
  • In-home support services
    10 hours/month
  • Part B premium reduction^
    $50
  • Primary care
    $0*/$30**
  • Specialist
    $35*/$60**
  • Premium
    $0
  • Urgent care
    $35 in- & out-of-network
  • Emergency room
    $120 in- & out-of-network
  • Ambulance
    $250*/40%*
  • Hospital daily copay: 1-7 days
    $300*/$500** daily
  • Therapy: PT, OT & speech
    $35*/$60**
  • Outpatient surgery
    $250*/20%**
  • Max out-of-pocket+
    In-network: $2,500; Combined in- & out-of-network: $5,000

*In-network; **Out-of network;
+Benefit reduces your monthly Part B premium; ^Payments for prescription drugs do not count toward annual maximum out-of-pocket limits

Out-of-network services 

Out-of-network/non-contracted providers are under no obligation to treat WellFirst Health Medicare Advantage members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service.

Call Customer Service at 877-301-3326 (TTY:711) or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

More Medicare details

Icon of book lying open

Medicare Advantage documents

Plan Guide

Detailed coverage and benefit information for WellFirst Health Medicare Advantage.
View 2021 plan guide

Summary of Benefits

Summarized benefit information for WellFirst Health Advantage plans.
See 2021 summary

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Learn about Medicare plans

Talk with our experts about our plans and what will fit your needs.
Meet with a sales person 

Receive a 2021 Medicare Enrollment Kit in the mail. You can also ask a WellFirst Health representative to contact you.
Request a 2021 Medicare kit 

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Medicare Advantage premiums

Extra Help for premium costs

If you receive Extra Help from Medicare to pay your Medicare prescription drug plan costs, your monthly WellFirst Health premium will remain at $0 per month.
Learn about Extra Help

Automatic premium withdrawal

Automatically withdraw any late enrollment penalty payment from your checking or savings account.
See automatic withdrawal PDF

Questions? Contact us.

Senior man using phone and laptop in his living room.Members
Talk with our Customer Care Center at 1-877-301-3326 (TTY:711).
 
Not a member?
Talk with a WellFirst Health Medicare sales rep at 1-833-551-0565. You can also call to ask for information in alternate formats and languages. 

Mailing address

WellFirst Health Medicare Advantage
PO Box 56099
Madison, WI 53705-9399
 
View our Medicare disclaimers

H8019_wellfirstbenefits.com
Updated 10/8/20