The Coverage Gap

Text Size

The Coverage Gap for 2010

The bottom line on the Coverage Gap.

After you and the insurance company together have spent a certain amount on prescriptions ($2,830 also known as your initial coverage limit), PDP coverage changes. You enter the gap. When you're in the gap you pay for all of your prescriptions yourself until you've spent $4,550.

After you've spent $4,550 of your own money on prescriptions (that includes all your co-pays and co-insurance before the gap, but does not includes your premium), coverage changes again—for the better. Catastrophic coverage begins and your PDP provider pays for about 95% of your remaining drug costs for that calendar year.

The reasons behind the gap.
When the government created PDPs, they wanted to provide some help to all members and a safety net for those with really high drug costs. Having a coverage gap was a way to provide some coverage for everyone, and also take care of the folks who are really struggling—and make it all affordable.

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 low or no co-pays on generic drugs. 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.

The coverage gap - WellCare Signature (PDP)

$4,550	Catastrophic Coverage	Catastrophic Coverage begins when you have spent $4,550 on drugs. For the rest of the year, WellCare pays 95% of your drug costs, while you pay 5%.
$2,830	The Coverage Gap	The Coverage Gap starts when you and WellCare have spent $2,830 on drugs. Now, you pay for 100% of your prescriptions (at WellCare's low, negotiated rate).
$0	Regular Coverage	Regular Coverage starts right away, because the WellCare Signature Plan has no deductible. You pay the co-payment for the prescriptions you receive (remember, there's no co-payment for generic drugs).

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 know how close you are to the coverage gap. That way, there are no surprises and you can budget accordingly.

On a limited income? The gap works differently for you.
If you're on a limited income there is no coverage gap, because you will always have some coverage. Here's how it works: after you and WellCare together have spent a certain amount on prescriptions (it is $2,830), coverage changes and most people will have a small co-payment for generic drugs until the total expense between you and the company reaches $4,550, at which time the co-pay returns to $0. For current members, please call Customer Service at 1-888-547-5252; prospective members call 1-888-908-5252 (TTY users should call 1-888-816-5252), Monday - Sunday, 7am to 2am Eastern for additional information.

Last modified: 06/16/2010