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Wellcare prescription plans

Because the ability to access affordable prescription medications is crucial to maintaining good health, beneficiaries must be aware of all their options.  In order to help individuals make an informed decision, we will discuss some benefits of the WellCare prescription drug plans.

Important; CMS has guidelines in place to regulate the types of medications that prescription drug plan providers must cover.  This includes a minimum standard of benefits for providers to follow. The formulary for each plan Each plan meets the requirements as required by law. Because each plan differs, the cost and drugs included in the formulary can vary.

Find out about the Medicare drug price negotiations

Although Wellcare offers three different plan choices, it is important to review each plan formulary and make sure it provides coverage to fit the prescription needs for anyone considering enrollment.

The three Wellcare PDP plans for 2024

Some features of the Wellcare prescription plans

Wellcare has no or low premium plans available to provide coverage for individuals who qualify for Extra Help.  These plans are available in all states and offer low or no copays when enrollees purchase prescriptions from preferred pharmacies.

Some Wellcare plans include no deductible, so plans cover prescriptions on day one.

Wellcare has a nationwide network of preferred pharmacies that includes thousands of national, regional and local pharmacy chains. It also includes grocers and independent pharmacies as well.  These relationships help plan members save money on prescription drugs.

Use this link to the Wellcare preferred pharmacy tool and find a local in-network pharmacy.

Find a preferred pharmacy tool to find a local pharmacy.

The member service representatives are available either online at wellcare.com/PDP or by phone at 866-822-1339 (TTY – 711) during the hours of 8am – 8pm EST Monday – Friday. They can provide answers to members coverage or medication questions.

If you want to view the plan formulary (complete list of drugs each plan covers), visit Wellcare’s website or contact their member services department.

What is the Part D  Penalty for Late Enrollment?

What is the Medicare Part D Penalty for late enrollment?  A part D late enrollment is when a beneficiary is without Medicare part d prescription drug coverage or other creditable prescription and medication coverage for a period of 63 days or more. It is a penalty fee for those who are uninsured. Generally, the policyholder will have to pay the penalty for as long as they hold the prescription drug coverage.

The cost of the part D late enrollment penalty changes yearly because it is calculated based on national averages. Medicare calculates the fee by multiplying 1% of the “national base beneficiary premium” by the number of months that the policyholder did not have Part D of Medicare (or other creditable coverage). In 2023, the national base beneficiary premium was $32.74.

How Does a Policyholder Know If They Have to Pay?

Once the beneficiary joins a Medicare part D drug coverage plan, the plan will then calculate their late enrollment penalty.

Reconsideration

Sometimes, insurance companies can make mistakes. If the policyholder does not agree with the application of this penalty, then the drug plan can send information on how to request what is known as a “reconsideration.”  However, by law, the late enrollment penalty is considered part of the beneficiary’s Medicare premium.  The premium must be paid (including the penalty).  Otherwise, the beneficiary runs the risk being unenrolled from their coverage.

If the reconsideration ends up being decided in the policyholder’s favor, meaning that the late enrollment penalty is not valid, then the Medicare drug plan can and will remove the late enrollment penalty fee. The plan will then send documentation to the policyholder explaining what happened and whether or not they are eligible to receive a refund. On the other hand, if the Medicare Part D contractor evaluates the reconsideration and finds that the late enrollment penalty is valid, then they will instead send the beneficiary documentation explaining why they must pay the penalty as part of their Medicare premium.

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