Your Guide To WellCare's Medicare Coverage Options

Key Takeaways:

• WellCare offers four types of Medicare Advantage plans: HMO plans, POS plans, PPO plans and SNP plans.

• Many of WellCare's Medicare Advantage plans also offer Part D prescription drug coverage. Still, some people may prefer to purchase one of WellCare's three standalone Part D plans.

• The WellCare Classic Part D plan is best suited for people who are only taking a few prescriptions. This plan offers a lower premium and is a recommended option for members who qualify for Extra Help.

• WellCare's Extra Part D plan is a great option for those who take several medications on a regular basis. This plan also offers low copays and a $0 deductible.

• WellCare's ValueScript Part D plan offers the lowest monthly premiums.

One of the most popular insurance companies WellCare, which was recently acquired by Centene, offers both Medicare Advantage plans and prescription drug plans nationwide. Serving more than 5.5 million Medicare members across the US, WellCare offers four Medicare Advantage options and three Part D options.

What Do I Need to Know About Medicare Advantage Plans?

Medicare Advantage plans are an optional substitute for Original Medicare. These plans are required to cover the same benefits as Original Medicare. However, they also provide benefits not included with Parts A or B. Each Medicare Advantage plan is unique. However, some of the most common additional benefits include:

• Hearing care

• Dental care

• Vision care

• Prescription drug coverage

• Fitness benefits

• Wellness programs

• An annual out-of-pocket limit that helps you forecast and control health costs

What Medicare Advantage Plans Does WellCare Offer?

WellCare offers four types of Medicare Advantage plans:

Health Maintenance Organization (HMO) Plans

With a WellCare HMO plan, members select a primary care physician (PCP). Your PCP oversees and coordinates all of your healthcare needs. If you need to see a specialist, your PCP will refer you to an appropriate provider within your plan's network.

This does limit your choices when selecting a specialist. An HMO can be an attractive option if you don't anticipate spending much time at the doctor's office and you prefer to have all of your needs taken care of within the same facility or network. With lower copays, coinsurance and premiums, HMOs are typically more affordable than other options.

Point of Service (POS) Plans

Point of Service plans are a type of HMO. These plans provide members with a bit more flexibility when choosing a provider. With a WellCare POS plan, you can obtain authorization to work with providers outside of your plan's network. You will still be encouraged to work with in-network providers. However, you may find the ability to venture outside of the plan's network to be an important selling point.

Preferred Provider Organization (PPO) Plans

With a WellCare PPO plan, members can seek care from any in-network provider without a referral. These plans are typically more expensive than other options. Still, those who require more flexibility may consider the higher copays and premiums a worthy tradeoff. WellCare offers PPO plans in certain counties in the following states:

• Florida

• Georgia

• New York

• South Carolina

Special Needs (SNP) Plans

WellCare's SNPs are designed to provide more personalized coverage for those who are:

• Living on a fixed or limited income

• Eligible for Medicare

• Eligible for Medicaid

Special Needs Plans often include:

• Hospital care coverage

• Doctor visit coverage

• Prescription drug coverage

• Vision coverage

• Dental coverage

• Help paying for transportation to and from healthcare appointments and pharmacies

• Discounts and allowances for OTC medications and other health supplies

WellCare offers Special Needs Plans in the following states:

• Arkansas

• Arizona

• California

• Connecticut

• Florida

• Georgia

• Hawaii

• Kentucky

• Louisiana

• Maine

• Michigan

• Mississippi

• North Carolina

• New Jersey

• New York

• Ohio

• South Carolina

• Tennessee

• Texas

What Do I Need to Know About Medicare Part D Plans?

Medicare prescription drug plans are available as an additional supplement to Original Medicare. These plans focus exclusively on helping their members cover the costs of prescription medications. Each Part D plan has a unique formulary. (This is the list of drugs the plan covers.)

It is essential to ensure that the drugs you are taking are included on your plan's formulary. Additionally, you'll want to review the plan's pharmacy network. If you have a favorite local pharmacy that you'd like to use, you should ensure it is in your plan's network.

Your out-of-pocket costs are typically lower when you fill your prescriptions at an in-network pharmacy. You'll also want to pay attention to which pharmacies are preferred. Your drug costs can be even further reduced when picked up at a preferred pharmacy. Enrolling in your plan's mail order pharmacy option can also increase your cost savings.

What Medicare Part D Plans Does WellCare Offer?

Many of WellCare's Medicare Advantage plans also offer Part D prescription drug coverage. Still, some people may prefer to purchase one of WellCare's three standalone Part D plans. These include:

WellCare Classic Part D Plan

The Classic plan is best suited for people who are only taking a few prescriptions. This plan offers a lower premium and is a recommended option for members who qualify for Extra Help.

• Premium: $31.30

• Deductible: $435

• Copayments/Coinsurance in Initial Coverage Stage:
  
  

WellCare Extra Part D Plan

WellCare's Extra plan is a great option for those who take several medications on a regular basis. This plan also offers low copays and a $0 deductible.

• Premium: $79.70

• Deductible: $0

• Copayments/Coinsurance:

WellCare ValueScript Part D Plan

WellCare's ValueScript plan is another excellent option for those who only occasionally take prescription medications that are readily available in the generic brand. Those taking less than three medications regularly may also find this plan to be a suitable match for their needs. Of all WellCare's Part D plan options, the ValueScript plan offers the lowest monthly premiums.

• Premiums: $10.40-$16.90 per month, depending on location

• Deductible: $0 for Tier 1 and Tier 2 Drugs; $415 for Tiers 3-5

• Copays/Coinsurance: Varies by location

What are WellCare's Prescription Delivery Options?

WellCare members can save time and money by signing up for prescription home delivery. Provided by CVS Caremark, this service provides multiple benefits. These benefits include:

• Convenience:

  • Members can skip the trip to the pharmacy and have their drugs delivered directly to their door. Additionally, members can receive up to a 90-day supply of their medication at a time.

• Cost savings:

  • Depending on your plan, you may receive discounts on your medications with mail order. Shipping is always free.

• Automatic refills and reminders:

  • With home delivery, you'll never have to worry about missing a refill. CVS Caremark will provide automated phone reminders. You can easily update your information or check your order status from their secure online portal.

What Additional Medicare Plan Benefits Does WellCare Offer?

In addition to the services covered by specific plans, WellCare further promotes the health of its members by providing ancillary benefits.

All members of WellCare's Medicare plans have access to the following benefits:

*To qualify for enrollment in WellCare's MTM program, you must meet each of the following three criteria:

1. You are taking eight or more maintenance medications covered under Medicare Part D

2. You are managing three or more of the following chronic conditions:

   1. Asthma

   2. Chronic Heart Failure

   3. COPD

   4. Depression

   5. Diabetes

   6. Osteoporosis

3. Your costs for prescription related expenses reach or exceed the annual cap. This cap is set at $4,255 in 2020.

Depending on your location, your WellCare plan may provide coverage for extra benefits.

• In Georgia, WellCare members may qualify for a free Weight Watchers membership.

• WellCare members in Kentucky may qualify for a free cell phone, sports physical or GED test.

• In Florida, members can take advantage of complimentary occupational or physical therapy.

• If you're in Nebraska, your WellCare plan can gain you admission to Health Fairs and WellCare Days events.

Samantha Lamph is a former English and creative writing professor with experience in health and finance writing.