How Can I Find Out if My Prescription Drugs are Covered by My WellCare Medicare Advantage or WellCare Standalone Prescription Drug Plan?

Last Updated : 10/21/20183 min read

If you have a WellCare Medicare Advantage plan or a stand-alone WellCare Medicare Prescription Drug Plan, and take prescription medications on a regular basis, you may want to know what coverage is available to help you lower your out-of-pocket costs. This article explains the process for understanding your prescription drug coverage under WellCare Medicare plans.

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How do WellCare Medicare Prescription Drug Plans work?

Whether you get your prescription drug coverage through a WellCare Medicare Advantage plan or have stand-alone Medicare Part D prescription drug coverage, your specific benefits depend on the plan’s formulary, or list of covered prescription drugs, and the benefit amounts available for each. Plans may change their formularies from time to time, but they must notify you in writing when they do.

What’s the difference between a Medicare Advantage Prescription Drug plan and a stand-alone Medicare Part D Prescription Drug Plan?

  • A stand-alone Medicare Prescription Drug Plan works alongside your Original Medicare, Part A and Part B, coverage to help pay your prescription drug costs.
  • A Medicare Advantage plan provides a different way to get your Original Medicare coverage. Medicare Advantage plans cover Medicare Part A and Part B benefits (except hospice care, which Part A still covers) and often include additional benefits, such as prescription drug coverage. So a Medicare Advantage Prescription Drug plan is a way to get your Medicare Part A, Part B, and Part D benefits in a single plan.

Please note that you must continue to pay your Medicare Part B premium, as well as any monthly premium required by your plan.

WellCare Medicare plans with prescription drug coverage may use different cost-control measures in their formularies, which may include:

  • Tiered formularies. Most WellCare Medicareplans that cover prescription drugs use between three and six tiers in their formularies. Basically, medications in the lower tiers, usually generic drugs, have lower copayments or coinsurance amounts, while prescription drugs in higher tiers typically cost you more.
  • Prior authorization. In some cases, your plan may require your doctor to get authorization before prescribing certain types or brands of prescription drugs.
  • Quantity limits. Some plans may limit the number of doses you can get at one time, or limit the number of refills during a specific time period.
  • Network pharmacies. Your plan may require you to use pharmacies in your WellCare Medicare plan network to access your benefits, or offer you lower out-of-pocket costs if you use preferred pharmacies.

How do I find out which prescription drugs are in my WellCare Medicare plan formulary?

If you have a stand-alone WellCare Medicare Prescription Drug Plan or a WellCare Medicare Advantage Prescription Drug plan, you can use WellCare’s convenient

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  • You can enter the name or first few letters of the medication in the search box.
  • You can search by letter of the alphabet.
  • You can search by class (analgesics, antibiotics, or cardiovascular, for example).

Results are displayed with important information about your coverage, such as:

  • The therapeutic class and sub-class of the medication
  • The drug’s dosage strength
  • Whether the medication is in the plan formulary and in which tier

You can use this provider search tool to find network and preferred pharmacies in your area, as well.

WellCare is a private insurance company approved by Medicare to offer stand-alone Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans under federal program regulations. Not all WellCare Medicare plans may be available in all locations, and plan benefits and out-of-pocket costs may vary depending on where you live.

Feel free to use the no-obligation Find Plans button on this page to compare your Medicare options. Find out more about WellCare.

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