What Types of Medicare Part D Coverage Does WellCare Offer?
This article was updated on: 10/21/2018
If you’re a Medicare beneficiary who takes prescription drugs, you may be wondering how Medicare prescription drug coverage (Part D) works and how you can get help with your medication costs. Wellcare offers a few Medicare plan options that include prescription drug benefits.
You can get your Medicare Part D prescription drug coverage through Wellcare in one of two ways:
- As part of a Wellcare MedicareAdvantage plan with prescription drug coverage (also known as a Medicare Advantage Prescription Drug plan)
- As a stand-alone Wellcare MedicarePart D Prescription Drug Plan that works with Original Medicare
It’s a good idea to sign up for Medicare Part D prescription drug coverage as soon as you are eligible; if you wait, you may have to pay a late-enrollment penalty each month with your Part D premium for as long as you are covered. This may apply any time that you go without Part D after you’re first eligible and don’t have creditable prescription drug coverage (insurance that pays, on average, as much as the Part D benefits) for 63 days in a row or more.
Here’s what you should know about the Medicare Part D prescription drug program and Wellcare Medicare plans that include this coverage.
Do all Wellcare Medicare Advantage plans have prescription drug coverage?
Wellcare is a private insurance company contracted with Medicare to offer Medicare Advantage plans (Part C), which are another way to get your Original Medicare, Part A and Part B, benefits. Medicare Advantage plans may offer benefits that go beyond the federal program, including prescription drug coverage; however, not every Medicare Advantage plan includes prescription drug benefits, and not all Wellcare Medicare Advantage plans may be available in all areas. It’s important to check if the plan you’re interested in includes prescription drug benefits before enrolling.
Medicare Advantage Prescription Drug plans may come in a few different types. Depending on where you live, you may be eligible to enroll in one of the following types of Wellcare Medicare Advantage plans, which may include prescription drug benefits:
- Wellcare MedicareAdvantage Health Maintenance Organization (HMO) plans. Wellcare Medicare Advantage Health Maintenance Organizations or HMOs often include prescription drug coverage. Health Maintenance Organization or HMO plans require you to select a primary care physician, and you must get all your care through the plan’s network in order to be covered, with the exception of medically necessary emergency or urgent care. If your plan includes prescription drug coverage, you may also need to use network pharmacies for your prescription medications.
- Wellcare MedicareAdvantage Preferred Provider Organization (PPO) plans. Most Preferred Provider Organization or PPO plans* also include Medicare Part D prescription coverage. These plans allow you to see any provider that accepts Medicare (both in-network and out-of-network), but you’ll pay less out of pocket if you use the plan’s preferred providers. You don’t need a referral if you need to see a specialist.
- Wellcare MedicareAdvantage Special Needs Plans (SNPs). These plans are limited to individuals with particular diseases or chronic conditions; those who live in institutions; or those who have both Medicare and Medicaid coverage. Special Needs Plans or SNPs tailor plan benefits to meet the unique needs of its members, and you must meet the eligibility criteria of the plan in order to enroll. These plans must include coverage for prescription drugs.
- Wellcare MedicareAdvantage Private Fee-for-Service (PFFS) plans. You can see any provider who accepts your Wellcare Medicare Private Fee-for-Service or PFFS plan’s payment terms and conditions, but it’s important to ask if they do each time you get medical services because providers are not required to treat you, even if they accept Medicare or even if they have treated you under the plan in the past. Some Wellcare Medicare Advantage Private Fee-For-Service or PFFS plans include prescription drug coverage; check with the specific plan to confirm whether this coverage is included.
If you want prescription drug coverage and you enroll in a Wellcare Medicare Advantage Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plan, make sure your plan includes it, because these two plan types cannot be combined with stand-alone Medicare Part D Prescription Drug Plans. Not all Private Fee-for-Service (PFFS) plans include Part D coverage; if prescription drug benefits aren’t available and you have a Private Fee-for-Service (PFFS) plan, you may be able to enroll in a Medicare stand-alone Prescription Drug Plan for this coverage.
You must continue to pay your Part B premium if you enroll in a Wellcare Medicare Advantage plan, plus any additional premium Wellcare requires for your Medicare Advantage coverage. Plan coverage and premiums may differ depending on where you live.
Does Wellcare offer stand-alone Medicare Part D Prescription Drug Plans?
If you are enrolled in Original Medicare, you may be eligible to enroll in a Wellcare stand-alone Medicare Part D Prescription Drug Plan. Original Medicare’s prescription drug benefits are limited to certain situations, such as medications you get as part of an inpatient hospital stay or certain prescription drugs you get in outpatient settings (such as infusion drugs). However, for most other types of prescription drug coverage, you’ll need to enroll in a stand-alone Medicare Prescription Drug Plan.
Wellcare offers stand-alone Medicare Part D prescription drug coverage in certain service areas; plan benefits and premiums can vary depending on location.
Hopefully, you now have a better idea of the types of prescription drug coverage available through Wellcare. If you’d like help finding Wellcare Medicare plans that may cover your medications, you can visit the Wellcare Medicare page to learn more about your plan options. Or, if you’re ready to start browsing, you can use the Find Plans button on this page to get started; if you like, you may enter the medications you currently take to tailor search results to Medicare plans that cover your specific prescription drugs.
*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.