The Coverage Gap for 2011

After you and/or others on your behalf have spent a certain amount on prescriptions ($2,840 also known as the initial coverage limit), your PDP coverage will change.

You enter the gap. You receive a discount on brand name drugs and pay only 93% of the costs for generic drugs until your out-of-pocket costs reach $4,550.

After your out-of-pocket costs reach $4,550 (that includes your deductible,co-pays and co-insurance but does not include your premiums), your coverage changes again—for the better. Catastrophic coverage begins and your PDP provider pays 95% of your remaining drug costs for that calendar year.

WellCare's inexpensive generic drugs help you avoid the gap.

At WellCare, we work hard to provide you with money-saving options that make the most of your coverage by offering $0 co-pays on generic drugs in our WellCare Signature (PDP) and $0 co-pays on generic drugs in our WellCare Signature (PDP). Not only does this help you get the most out of your coverage (because WellCare is paying for virtually all your drug costs), it also keeps costs low in general, so you won't enter the gap as fast—if at all.

Below is an example of the WellCare Signature (PDP) Plan and the coverage stages you go through as a member of our plan.

$4,550	Catastrophic Coverage	Catastrophic Coverage begins when your out-of-pocket costs reach $4,550. For the rest of the year, WellCare pays 95% of your drug costs, while you pay 5%.
$2,840	Coverage Gap	Coverage Gapstarts when you and/or others on your behalf have spent $2,840 on drugs. You receive a discount on brand name drugs and pay only 93% of the costs of generic drugs.
$0	Initial Coverage Stage	Initial Coverage Stage starts right away, because the WellCare Signature Plan has no deductible. You pay the co-pays/coinsurance for the prescriptions you receive (remember, there's $0 co-pays for generic drugs) until you and/or others on your behalf have spent $2,840.

WellCare helps you keep track of the gap.

At WellCare, we give you a monthly statement that tracks your spending and ours—so you always where you are at with your drug spend. That way, there are no surprises and you can budget accordingly.

Benefits, limitations, co-payments and restrictions may vary by plan and by region. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. You must continue to pay your Medicare Part B premium. WellCare uses a formulary. Benefits, formulary, pharmacy network, premium and/or co-payments/coinsurance may change on January 1, 2012. You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You can also call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778) between 7am to 7pm Monday through Friday, or call your state Medicaid office.