Certified Senior Advisor [CSA]®
Certified Senior Advisor [CSA]®
Kelly Blackwell is a Certified Senior Advisor [CSA]®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Quick WellCare Medicare Prescription Drug Plans review: WellCare offers Medicare Part D prescription drug coverage through standalone Part D plans and Medicare Advantage Plans. Monthly premium prices vary depending on where you live and which type of plan you choose. You can find Centers for Medicare and Medicaid Services [CMS] quality rating information for each plan by searching Medicare.gov.
WellCare Healthplans, Inc. began offering Medicare Part D prescription drug plans [PDPs] in 2006. WellCare was founded in 1985 and acquired by Centene Corporation in January 2020. Since then, WellCare has been Centene’s largest government-sponsored health care programs provider.
If you have Original Medicare Part A and/or B or a Private Fee-for-Service [PFFS] Medicare Advantage Plan, you can purchase one of WellCare’s standalone Part D plans. If you have a WellCare Preferred Provider Organization [PPO] or Health Maintenance Organization [HMO] Medicare Advantage Plan, your plan should include drug coverage.
Compare Wellcare’s Prescription Drug Plans [PDPs] available in your area on Wellcare’s website.
Pros and Cons of WellCare Medicare Part D Plans
What do WellCare Medicare Part D Plans cover?
WellCare Medicare Part D plans are regulated by CMS and must cover a wide range of prescription drugs that people with Medicare take. Plans include a coverage gap that begins when you and your plan have spent a certain amount [$4,430 in 2022] on prescription drugs and ends when you’ve spent $7,050 and enter the catastrophic coverage period. You then will pay a small coinsurance percentage or copay amount for drugs you need until the end of the year. When you are in the coverage gap, you will pay up to 25% of drug costs.
WellCare has a formulary [list of drugs] and separates drugs into tiers that correspond to costs. Lower tiers include generic, lower-cost medications, and higher tiers include higher-cost, brand name, or specialty drugs.
Your share of costs for each prescription drug may change depending on which pharmacy you choose, the tier of the drug, and when you enter each coverage phase. You must meet your annual deductible before your plan pays. Wellcare’s Part D plans include:
- Discounts for preferred retail pharmacies [CVS and Caremark] and three-month prescriptions.
- Options for one-month and three-month mail-order prescriptions
- Permission to use any pharmacy if you get Extra Help to to pay for medications
- Senior Savings Program for select insulins to keep your costs below $35/month
What are WellCare’s Medicare Part D Plan options?
WellCare offers three different Part D Plan options, including a value plan with lower monthly premiums, a medium range plan, and a value plus plan. Initial coverage limits and annual out-of-pocket threshold amounts are the same for all three plans. The difference among the plan options lies in the amount you pay for the monthly premium.
WellCare’s Value Script plan has the lowest monthly premium and no deductible for drugs in tiers one and two. It may be best for you if you don’t need prescription drugs but need prescription drug coverage to avoid paying late penalties. The Value Plus plan has a higher monthly premium but no annual deductible. The WellCare Classic plan includes a moderate monthly premium, but you still pay an annual deductible before your plan starts paying.
Before choosing a plan, make sure your drugs are on WellCare’s formulary, and your pharmacy is in WellCare’s network. Wellcare’s preferred pharmacies are CVS and Caremark. You can keep your costs lower by using preferred pharmacies and asking your doctor for generic versions of drugs if possible.
Understand Wellcare’s rules about how you get your prescription drugs. Prior authorizations may apply. You may have to try drugs on a lower tier first before your plan approves higher-cost drugs. This is called step-wise therapy.
Compare these 2022 WellCare Medicare Part D Plans in Cook County, Illinois:
*Based on pricing in Cook County, Illinois
Wellcare Medicare Part D Plans Reviews and Ratings
The Centers for Medicare and Medicaid Services [CMS] rate Wellcare’s Medicare Part D and Medicare Advantage plans. The Better Business Bureau [BBB] rates Centene, WellCare’s parent company. Consumer Affairs, NCQA, and J.D. Power don’t rank WellCare’s Part D plans separately, but provide insight into Wellcare’s health and Medicare Advantage Plans.
Learn More From Our Sources
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Wellcare is accepted at over 60,000 network pharmacies nationwide. Our network includes major chains, independent retail pharmacies, mail-service, long-term care, home infusion and Indian Health Service/Tribal/Urban Indian Health Program [I/T/U] pharmacies.
As a member, you may have your prescriptions filled by any network pharmacy. However, the amount you pay may be lower if you fill your prescription through CVS/Caremark mail-service pharmacy which offers preferred cost sharing instead of a network retail pharmacy that offers standard cost-sharing. Some pharmacies offer both retail and mail-services. If you fill your prescription with a retail pharmacy that also offers mail-service, your co-pay may be different.
You have the choice to sign up for automated mail service delivery. You can get prescription drugs shipped to your home through our network mail service delivery program. You should expect to receive your prescription drugs within 7–10 business days from the time that the mail service pharmacy receives the order. If you do not receive your prescription drugs within this time, please contact us at 1-866-808-7471 or visit Wellcare Mail Order Pharmacy Coverage.
When you fill your prescription at a participating pharmacy, you will simply need to present your Wellcare ID card. You will be responsible for any necessary out of pocket expense according to your Part D benefit.
Wellcare has contracts with pharmacies that equal or exceed the Centers for Medicare and Medicaid Services [CMS] requirements for pharmacy access in your area. Beneficiaries must use network pharmacies to access their prescription drug benefit. Benefits, formulary, pharmacy network, premium and/copayments/coinsurance may change on January 1 of each year.
If an in-network pharmacy is not available, you may need to use an out-of-network pharmacy to fill your prescriptions. An out-of-network pharmacy is a retail, long-term care, home infusion, or ITU pharmacy that is not in your plan’s network.
As a rule, your plan only covers prescription drugs filled at out-of-network pharmacies if you are unable to use a network pharmacy for any of these reasons:
- The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
- There are no participating network pharmacies when you travel outside of your service area
- The covered drug is prescribed for a medical emergency or urgent care and you are unable to fill your prescription immediately at a network pharmacy because there are no 24-hour network pharmacies within a reasonable driving distance
- The covered drug is out of stock at any network pharmacy in your area
- The covered drug [incl. high-cost and/or special drugs] cannot be obtained through CVS Caremark Mail Service Pharmacy or AcariaHealth pharmacy due to the medication being out-of-stock or any other reasons
- You are administered a vaccine covered by your plan in a physician’s office
Please note that even if we pay for covered prescription drugs filled at an out-of-network pharmacy, you may still pay more than you would have paid if you had filled your prescriptions at an in-network pharmacy.
To receive reimbursement for our portion of your cost, you will have to submit a Direct Member Reimbursement Form . Mail the completed Direct Member Reimbursement form along with a prescription label or pharmacy printout and a cash register receipt for your covered prescription drug to:
Wellcare Reimbursement Department PO Box 31577
Tampa, FL 33631-3577
We will review the Direct Member Reimbursement Request form and make an initial out-of-network coverage determination. Your request will be processed according to your benefit coverage and you will be notified of the outcome. If our Direct Member Reimbursement policy requirements are met, you will be reimbursed at the “any willing provider in-network contracted rate” instead of the cash price minus any applicable co-pays. That means that you will pay the copay/co-insurance you would be responsible for under your plan plus the difference between the cash price and the plan allowance if the cash price is higher than the contracted rate.
If you are a Low-Income Subsidy [LIS] beneficiary, the out-of-network differential will be paid by CMS [i.e. you will only pay the applicable LIS copay].
For additional information please contact us.
Learn more about coverage determinations and exceptions on the Centers for Medicare and Medicaid Services website.