Questions and Answers
- What is a Prescription Drug Plan?
- When can I enroll or make a plan change into a WellCare Prescription Drug Plan?
- Should I still keep my Medicare Card?
- What prescriptions are covered by WellCare?
- What if I don't see my prescription listed in the WellCare Abridged Formulary?
- What pharmacies can I use my WellCare ID card to get my prescription drugs?
- Why wouldn't I need a PDP?
- What happens if I don't enroll in a Prescription Drug Plan when I become eligible for Medicare?
- Can I get prescriptions through a mail service?
- I'd like to get a 3-month supply of my drugs. Is that possible?
- What is Exactus Pharmacy Solutions?
- Can a PDP refuse me coverage if I take a lot of prescriptions?
- I get some of my prescriptions through Medicare Part B. Now what?
- What if I'm on a limited income?
- What if I have to pay full price for my prescription because I do not have my WellCare insurance card?
Q - What is a Prescription Drug Plan?
A - Medicare prescription drug plans are also known as Medicare Part D. Medicare Part D is a government program that offers prescription drug insurance to everyone eligible for Medicare. Part D is different from Medicare Part A and Part B. Once you become Medicare eligible, you must enroll in a plan as you will not be automatically enrolled and you can do so with companies like WellCare.
The federal government has specific guidelines for the types of medications that must be covered along with setting a minimum standard of benefit that organizations must follow. Each plan has a formulary that meet these requirements as required by law. But keep in mind, not all plans are the same. They may vary in cost or specific drugs covered. If you choose to enroll in a Medicare Part D plan, please review the plan's formulary to ensure it will meet your prescription drug coverage needs.
Q - When can I enroll or make a plan change into a WellCare Prescription Drug Plan?
A - You can enroll or make a plan change into a WellCare Prescription Drug Plan three months before to three months after the month you turn 65 which is your Initial Enrollment Period. You can also enroll in or switch to a new plan during the Annual Enrollment Period (October 15 - December 7 of every year) in which your new coverage would be effective January 1st. There are also exceptions throughout the year that may allow you to make plan changes outside of the Annual Enrollment Period. Contact Customer Service for more information.
Q - Should I still keep my Medicare Card?
A - Definitely. You'll still need for your Medicare covered services when you go to any doctors' appointments, hospital visits, medical tests - anything that has to do with your healthcare. You will only need your WellCare member ID card when you fill any prescriptions for Part D drugs.
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Q -What prescriptions are covered by WellCare?
A - Brand-name and generic prescription drugs are covered by WellCare. The federal government has created guidelines for the types of drugs that must be covered, along with setting a minimum standard of benefits. You can review our full list of our covered prescription drugs either by using our search tool or you can download a comprehensive formulary.
Q -What if I don't see my prescription listed on the WellCare Abridged Formulary?
A - Don't worry. It is likely that we cover your drug or have an alternative for you. You can review our full list of our covered prescription drugs by using our search tool or you can call us and we can look up your prescription to see if its part of our formulary. For current members call Customer Service at 1-888-550-5252, Monday - Friday, 8am to 2am Eastern. Prospective members call 1-866-765-4390 Monday - Friday, 8am to 2am Eastern. TTY users should call 1-888-816-5252. When you call, the pharmacy representative may also suggest a preferred brand or preferred generic equivalent of your prescription. By using these, you can save substantially. If your doctor feels that you need to take a certain brand name prescription drug that isn't covered, we have a review process in place that may allow you to do this. Read our Part D Transition Policy.
Q -What pharmacies can I use my WellCare ID card to get my prescription drugs?
A - You can use your WellCare ID card at any of our 60,000 network pharmacies. Some our of network pharmacies include popular retail stores such as Walgreens, CVS, Rite Aid, Target, Walmart, and Costco. Use our pharmacy search tool to find a pharmacy in your area.
Q - Why wouldn't I need a PDP?
A - You wouldn't need a PDP if you had VA benefits, TRICARE or if you are enrolled in a Medicare Advantage that has prescription drug coverage (HMO or PPO). If you enroll in a PDP, you would be automatically disenrolled from your Medicare Advantage plan. Also, If you currently have health coverage from an employer or union, joining WellCare could affect your employer or union health benefits. You could lose your employer or union health coverage if you join WellCare.
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A - Medicare prescription drug plans are also known as Medicare Part D. Medicare Part D is a government program that offers prescription drug insurance to everyone eligible for Medicare. Part D is different from Medicare Part A and Part B. Once you become Medicare eligible, you must enroll in a plan as you will not be automatically enrolled and you can do so with companies like WellCare.
The federal government has specific guidelines for the types of medications that must be covered along with setting a minimum standard of benefit that organizations must follow. Each plan has a formulary that meet these requirements as required by law. But keep in mind, not all plans are the same. They may vary in cost or specific drugs covered. If you choose to enroll in a Medicare Part D plan, please review the plan's formulary to ensure it will meet your prescription drug coverage needs.
Q - When can I enroll or make a plan change into a WellCare Prescription Drug Plan?
A - You can enroll or make a plan change into a WellCare Prescription Drug Plan three months before to three months after the month you turn 65 which is your Initial Enrollment Period. You can also enroll in or switch to a new plan during the Annual Enrollment Period (October 15 - December 7 of every year) in which your new coverage would be effective January 1st. There are also exceptions throughout the year that may allow you to make plan changes outside of the Annual Enrollment Period. Contact Customer Service for more information.
Q - Should I still keep my Medicare Card?
A - Definitely. You'll still need for your Medicare covered services when you go to any doctors' appointments, hospital visits, medical tests - anything that has to do with your healthcare. You will only need your WellCare member ID card when you fill any prescriptions for Part D drugs.
Top
Q -What prescriptions are covered by WellCare?
A - Brand-name and generic prescription drugs are covered by WellCare. The federal government has created guidelines for the types of drugs that must be covered, along with setting a minimum standard of benefits. You can review our full list of our covered prescription drugs either by using our search tool or you can download a comprehensive formulary.
Q -What if I don't see my prescription listed on the WellCare Abridged Formulary?
A - Don't worry. It is likely that we cover your drug or have an alternative for you. You can review our full list of our covered prescription drugs by using our search tool or you can call us and we can look up your prescription to see if its part of our formulary. For current members call Customer Service at 1-888-550-5252, Monday - Friday, 8am to 2am Eastern. Prospective members call 1-866-765-4390 Monday - Friday, 8am to 2am Eastern. TTY users should call 1-888-816-5252. When you call, the pharmacy representative may also suggest a preferred brand or preferred generic equivalent of your prescription. By using these, you can save substantially. If your doctor feels that you need to take a certain brand name prescription drug that isn't covered, we have a review process in place that may allow you to do this. Read our Part D Transition Policy.
Q -What pharmacies can I use my WellCare ID card to get my prescription drugs?
A - You can use your WellCare ID card at any of our 60,000 network pharmacies. Some our of network pharmacies include popular retail stores such as Walgreens, CVS, Rite Aid, Target, Walmart, and Costco. Use our pharmacy search tool to find a pharmacy in your area.
Q - Why wouldn't I need a PDP?
A - You wouldn't need a PDP if you had VA benefits, TRICARE or if you are enrolled in a Medicare Advantage that has prescription drug coverage (HMO or PPO). If you enroll in a PDP, you would be automatically disenrolled from your Medicare Advantage plan. Also, If you currently have health coverage from an employer or union, joining WellCare could affect your employer or union health benefits. You could lose your employer or union health coverage if you join WellCare.
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Q-What happens if I don't enroll in a Prescription Drug Plan when I become eligible for Medicare?
A-It's important to sign up when you become eligible for Medicare in order to avoid a Medicare Late Enrollment Penalty. If you don't have or get other Medicare prescription drug coverage or creditable prescription drug coverage (as good as Medicare’s) for a continuous period of 63 days or more, you may have to pay a late enrollment penalty in addition to your premium for Medicare prescription drug coverage in the future. If you qualify for certain exceptions such as receiving Extra Help, you may not be required to pay this penalty.
A-It's important to sign up when you become eligible for Medicare in order to avoid a Medicare Late Enrollment Penalty. If you don't have or get other Medicare prescription drug coverage or creditable prescription drug coverage (as good as Medicare’s) for a continuous period of 63 days or more, you may have to pay a late enrollment penalty in addition to your premium for Medicare prescription drug coverage in the future. If you qualify for certain exceptions such as receiving Extra Help, you may not be required to pay this penalty.
Q -Can I get prescriptions through a mail service?
A - Yes, Exactus Pharmacy Solutions is WellCare's preferred mail service provider that can deliever your prescriptions right to your door. In fact, you may save 17%* on a 3-month supply of maintenance medications when using our preferred mail service provider. Best of all, using Exactus can help you stay out of the Medicare coverage gap. Learn more about Exactus Pharmacy Solutions and the benefits they offer.
*This savings occurs when you use Exactus Pharmacy Solutions, WellCare's preferred mail service pharmacy as compared to using a non-preferred mail service pharmacy.
Q -I'd like to get a 3-month supply of my drugs. Is that possible?
A - You can get a 3-month supply of most drugs (with the exception of drugs in our Specialty Tier) when you use a pharmacy that contracts to offer 3-month supplies. If you use WellCare's preferred mail service provider, Exactus Pharmacy Solutions, you may save 17%* on a 3-month supply of maintenance medications. Learn more about our Exactus Pharmacy Solutions.
*This savings occurs when you use Exactus Pharmacy Solutions, WellCare's preferred mail service pharmacy as compared to using a non-preferred mail service pharmacy.
Q -What is Exactus Pharmacy Solutions?
A -Exactus (formerly known as WellCare Specialty Pharmacy) is a WellCare company and a licensed pharmacy registered in all 50 states. As a licensed pharmacy, Exactus can service members regarding their pharmaceutical needs and deliver medications and supplies to our members living throughout the country for their specialty and mail service needs.
Q -Can a PDP refuse me coverage if I take a lot of prescriptions?
A - As long as you are eligible, no PDP can refuse to offer you coverage. To lower your prescription drug costs, you should also consider using our preferred generic drugs, which are usually less expensive than brand drugs.
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Q - I get some of my prescriptions through Medicare Part B. Now what?
A - You'll continue to receive them through Part B. And, as always, prescriptions received as part of a physician's services or because of surgery (as well as certain prescription drugs used in nebulizers and external infusion pumps) are covered through Part B.
Q -What if I'm on a limited income?
A - If you are on a limited income, you may qualify for extra help from the government — and if you're eligible, this assistance could reduce the cost of your monthly plan premiums, deductibles and co-pays/coinsurance.
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Q - What if I have to pay full-price for my prescription because I do not have my WellCare ID card?
A - You will need to complete a WellCare Direct Member Reimbursement Form for reimbursement.
When completing the form, you will need to provide your information or the member’s information if you are filling it out for someone else. This information includes the member’s information such as Name, Birthdate, ID Number, and current Address. Also, the form includes a section for the pharmacy that dispensed the prescription and the specific prescription information that you (or the member) paid cash for. The form provides helpful information on where to locate the necessary information on the prescription label when you are completing the DMR form. Please be sure to include a detailed prescription receipt or pharmacy printout. The prescription receipt or pharmacy printout must include the member’s name, pharmacy name, physician name, drug name, drug strength, quantity, NDC number, days supply and the amount paid by the patient. Handwritten receipts will not be accepted. If you have questions about the prescription or pharmacy information, please contact the pharmacy that dispensed your medication. Or, you can call the Customer Service Phone number listed on the back of your WellCare ID card. It is extremely important to completely fill out the DMR form. Also, make sure that you keep a copy of the form and the receipts for your records.
Top
Q -Can a PDP refuse me coverage if I take a lot of prescriptions?
A - As long as you are eligible, no PDP can refuse to offer you coverage. To lower your prescription drug costs, you should also consider using our preferred generic drugs, which are usually less expensive than brand drugs.
Top
Q - I get some of my prescriptions through Medicare Part B. Now what?
A - You'll continue to receive them through Part B. And, as always, prescriptions received as part of a physician's services or because of surgery (as well as certain prescription drugs used in nebulizers and external infusion pumps) are covered through Part B.
Q -What if I'm on a limited income?
A - If you are on a limited income, you may qualify for extra help from the government — and if you're eligible, this assistance could reduce the cost of your monthly plan premiums, deductibles and co-pays/coinsurance.
Top
Q - What if I have to pay full-price for my prescription because I do not have my WellCare ID card?
A - You will need to complete a WellCare Direct Member Reimbursement Form
for reimbursement.When completing the form, you will need to provide your information or the member’s information if you are filling it out for someone else. This information includes the member’s information such as Name, Birthdate, ID Number, and current Address. Also, the form includes a section for the pharmacy that dispensed the prescription and the specific prescription information that you (or the member) paid cash for. The form provides helpful information on where to locate the necessary information on the prescription label when you are completing the DMR form. Please be sure to include a detailed prescription receipt or pharmacy printout. The prescription receipt or pharmacy printout must include the member’s name, pharmacy name, physician name, drug name, drug strength, quantity, NDC number, days supply and the amount paid by the patient. Handwritten receipts will not be accepted. If you have questions about the prescription or pharmacy information, please contact the pharmacy that dispensed your medication. Or, you can call the Customer Service Phone number listed on the back of your WellCare ID card. It is extremely important to completely fill out the DMR form. Also, make sure that you keep a copy of the form and the receipts for your records.
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S5967_NA018433_PDP_WEB_ENG CMS Approved MMDDYYYY
Pending CMS Approval
Last modified: 04/09/2012
