Is a WellCare Medicare Advantage Prescription Drug Plan the Same as a Standalone Medicare Prescription Drug Plan?

Steven Mott by Steven Mott | Licensed since 2012

This article was updated on: 10/21/2018

If you’re just starting to learn more about Medicare prescription drug coverage (Part D), you may be wondering what your options are and what the difference is between a Medicare Advantage Prescription Drug plan and a stand-alone Medicare Prescription Drug Plan.

A Wellcare Medicare Advantage plan with prescription drug coverage (Part C) (sometimes referred to as a Wellcare MAPD plan) covers your Part A, Part B, and Part D benefits under a single plan. These plans are not the same as stand-alone Wellcare Medicare Part D Prescription Drug Plans, which work alongside Original Medicare, Part A and Part B.

Here are some important differences between the two to help you understand the type of Wellcare Medicare plan that may work for your prescription drug needs.

What is Wellcare Medicare Part D prescription drug coverage?

The United States Congress authorized the Medicare Part D prescription drug program in 2003 and the Medicare Part D benefit went into effect for the first time in 2006.

Under the program, any Medicare plan with prescription drug coverage must provide benefits for a broad range of generic and brand-name medications used to treat many different types of illnesses, diseases, and conditions, including medications in certain protected drug classes. Each Medicare plan that includes prescription drug coverage outlines its benefits in its formulary, which is a list of covered medications and the plan costs for each prescription drug. Plans may change their formularies from time to time, but they must notify you in writing before they do.

What types of Medicare Part D coverage does Wellcare offer?

Medicare Part D coverage is available through Medicare-approved private insurance companies like Wellcare. As mentioned, Wellcare offers Medicare Part D prescription drug coverage through either a Wellcare Medicare Advantage plan with prescription drug coverage or through a stand-alone Wellcare Medicare Part D Prescription Drug Plan.

Wellcare Medicare Advantage plans offer an alternate way to get your benefits under Original Medicare. These plans must cover at least the same level of coverage as Original Medicare (except for hospice, which is still covered through Part A); many plans also include prescription drug coverage as an additional benefit beyond Original Medicare. Some plans may also cover routine vision or dental services, wellness programs, or hearing care; these benefits aren’t normally covered under Original Medicare.

Another benefit of a Wellcare Medicare Advantage Prescription Drug ( Part C) plan is that it provides your Part A, Part B, and Medicare Part D coverage under one convenient plan. You must continue to pay your Part B premiums if you enroll in a Wellcare Medicare Advantage plan, plus any additional plan premium required for your Medicare Advantage coverage. Not all plans may be offered in all areas, and plan benefits and premiums may vary from place to place.

In general, if you want prescription drug benefits, you should enroll in a Medicare Advantage plan that includes prescription drug coverage. For example, if you enroll in a Wellcare Medicare Advantage Health Maintenance Organization (HMO) plan or Preferred Provider Organization* (PPO) plan and you want Medicare Part D prescription drug coverage, be sure it’s included in the plan you select, because these two Wellcare Medicare Advantage plan types cannot be combined with a stand-alone Wellcare Medicare Part D Prescription Drug Plan. If you enroll in a stand-alone Medicare Part D Prescription Drug Plan while you are already enrolled in a Medicare Advantage Prescription Drug plan, you may be automatically dis-enrolled from your Medicare Advantage plan and returned to Original Medicare.

There are exceptions. Some types of Medicare Advantage plans may be combined with stand-alone Medicare Part D prescription drug coverage if they don’t include prescription drug benefits (such as Medicare Savings Account plans and certain Private Fee-for-Service plans). Always check with the Medicare Advantage plan if Part D benefits are available and how your enrollment may affect other types of coverage you may have.

As another option, Wellcare Medicare Part D Prescription Drug Plans are designed to work with your Original Medicare coverage. If you’re currently enrolled in Original Medicare, you may not realize that Part A and Part B offer limited prescription drug benefits. For example, you’re covered under Part A for any medically necessary medications you may need as part of your inpatient hospital or skilled nursing stay. You’re covered under Part B for prescription drugs you get in outpatient settings (like a doctor’s clinic); these tend to be the types of medications that you can’t give yourself (such as infusion or chemotherapy drugs). However, if you want help with other medication costs, you’ll need to enroll in a stand-alone Medicare Prescription Drug Plan. You’d need to stay enrolled in Part A and/or Part B for your hospital and medical coverage. Stand-alone Medicare Prescription Drug Plans only cover medications; they don’t offer health benefits.

Which Wellcare Medicare plan with prescription drug coverage is right for me?

This is a personal decision and may come down to your specific preferences. Some people who travel frequently may like the flexibility of Original Medicare, which in most cases lets you see any provider in the country that accepts Medicare; in this case, you might prefer to enroll in a stand-alone Medicare Prescription Drug Plan for your Part D coverage.

If you’re interested in getting coverage beyond your Part A and Part B coverage (for example, routine vision benefits), you might be interested in a Medicare Advantage Prescription Drug plan, which may include prescription drug benefits, along with additional benefits that Original Medicare doesn’t cover. Since benefits may vary by plan, always check with the specific Medicare Advantage plan if there’s a specific benefit you’re interested in.

Whichever plan type you choose, it’s important to get Medicare Part D prescription drug coverage as soon as you are eligible, or you may have to pay a late-enrollment penalty with your monthly premium for as long as you have coverage. You may owe a late-enrollment penalty any time that you go without Part D coverage after you’re first eligible and don’t have other creditable prescription drug coverage (insurance that is as good as Part D) for 63 days in a row or more.

Would you like help finding Wellcare Medicare Advantage Prescription Drug plans or stand-alone Medicare Prescription Drug Plans that cover your medications? To learn more about Wellcare Part D coverage, visit the Wellcare Medicare page to find prescription drug coverage that fits your preferences and needs. If you’d like to start browsing now from the convenience of your home, you can use the Find Plans button to view plan options right away.

*Out-of-network/non-contracted providers are under no obligation to treat Wellcare 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. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Steven Mott |
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