Q - Should I still keep my Medicare Card?
A - Definitely. You'll still need to use it for all your doctors' appointments, hospital visits, medical tests— anything that has to do with healthcare.
Top
Q -What prescriptions are covered by WellCare?
A - Read the full list of our covered prescription drugs (also called a formulary).
For information on Excluded Drugs, please click here to access the Evidence of Coverage (Chapter 3).
Q -What if I don't see my prescription listed in the WellCare Abridged Formulary?
A - Don't worry. It is likely that we cover your drug or have an alternative for you. For current members call Customer Service at 1-888-547-5252, for prospective members call 1-888-908-5252 (TTY users should call 1-888-816-5252), Monday - Sunday, 7am to 2am Eastern. When you call, the pharmacy representative may also suggest a preferred brand or 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, we have a review process in place that may allow you to do this. Need time to consult your doctor? Read our Transition Policy.
Q -Can I use my WellCare card at a lot of different pharmacies?
A - You may use your WellCare card at any of over 64,000 pharmacies in our network. Find a pharmacy.
Q - Why wouldn't I need a PDP?
A - If you are enrolled in a Medicare Advantage HMO and want to stay in that HMO, you should not enroll in a PDP — the government will automatically disenroll you from your HMO plan!
Top
Q -Can I get prescriptions through the mail with WellCare?
A - Yes. Learn more.
Q -I'd like to get 93-day refills of my drugs. Is that possible?
A - Of course. The cost for a 93-day supply is three times the cost of a 31-day supply at pharmacies contracted to dispense a 93-day supply. To find out if your pharmacy is contracted to dispense a 93-day supply, please contact Customer Service.
Q -Can I get drugs from another country through WellCare?
A - We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and Territories, even for a medical emergency.
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. You should also consider using generic drugs, which are less expensive than brand drugs.
Review the savings example.
Top
Q - What if I don't understand something on this site?
A - At WellCare, we're committed to making this program truly easy. Just contact us by phone or e-mail. We'll take as much time as you need to answer any questions you have.
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 - You may qualify for extra help from the government — and if you're eligible, this assistance could really reduce the cost of your premiums, deductibles and/or co-pays/coinsurance. Learn more.
Top
Q - What if I have to pay full-price for my prescription because I do not have my WellCare insurance card?
A - You will need to complete a Direct Member Reimbursement (DMR) Form.
Download a Direct Member Reimbursement Form
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 DMR 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 membership 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.
Q - How will I know if WellCare is going to pay me for the prescriptions when I did not have my WellCare insurance card?
A - WellCare will send you a letter that informs you of our decision concerning the request for payment of your the prescriptions. You should expect to receive this letter within 7 - 10 business days.
Q - What if I mailed my request for WellCare to pay for my prescriptions four weeks ago, but I have not received any information?
A - Please contact the Customer Service Phone number listed on the back of your WellCare membership card. They will be able to provide you information including whether or not WellCare has received your request.
Q - Can I make a plan change from one WellCare Prescription Drug Plan to another?
A - WellCare is accepting plan changes for those who will have effective dates of January 1, 2010 and forward.
Q - Can I enroll in a WellCare Prescription Drug Plan?
A - WellCare is accepting new enrollees in our Prescription Drug Plan for those who will have effective dates of January 1, 2010 and forward.
If your coverage has been terminated for failure to pay your premiums:
Q - I went to the pharmacy and I just found out I do not have coverage. What can I do to get it back?
A - Your prescription drug coverage through WellCare has terminated for failure to pay your Part D premium by the end of the grace period, which is the last day of the month. Unless you fall into one of the exceptions below, your coverage cannot be reinstated. This means you no longer have prescription drug benefits through WellCare. There are assistance programs available. Contact your local State Health Insurance Program (SHIP) to see what assistance they can provide. Also, contact your doctor as soon as possible or before your current prescription runs out. You need to work with him/her on a treatment plan that is right for you. Additionally, he/she may be able to offer a lower cost alternative for you.
Exceptions
1. You are able to supply proof that the premiums were paid prior to the grace period - such as a copy of the cancelled check or bank statement - proving the check was posted timely.
2. You have a State Pharmaceutical Assistance Program (SPAP) who pays the complete premium and can provide documentation to prove you had the SPAP coverage for the premium period and the short payment would be covered by the SPAP.
3. You have been set up for SSA deduction and can provide copies of your statement showing premiums have been taken out of your check.
4. You have proof of address change - copy of current utility bill to show that you did not receive notification.
Q - Why do I not have a longer grace period for my February premium since I paid the January premium before the end of the grace period?
A - All premiums that become due within the last day of the month of the grace period must be paid, to bring you current. You did not pay for your premiums which were during the grace period coverage periods so you were disenrolled. There are assistance programs available. Contact your local State Health Insurance Program (SHIP) to see what assistance they can provide. Please call WellCare customer service at 1-888-550-5252 (TTY users call 1-888-816-5252) Monday - Sunday, 7am to 2am Eastern, and one of our agents can provide you with your local SHIP contact information. Also contact your doctor as soon as possible or before your current prescription runs out. You need to work with him/her on a treatment plan that is right for you. Additionally he/she may be able to offer a lower cost alternative for you.
Q - Under what conditions could my coverage with WellCare be reinstated?
A - Please contact Customer Service at 1-888-550-5252 (TTY users call 1-888-816-5252) Monday - Sunday, 7am to 2am Eastern if you fall into one of the following categories:
1. You are able to supply proof that the premiums were paid prior to the grace period - such as a copy of the cancelled check or bank statement - proving the check was posted timely.
2. You have a State Pharmaceutical Assistance Program (SPAP) who pays the complete premium and can provide documentation to prove you had the SPAP coverage for the premium period and the short payment would be covered by the SPAP.
3. You have been set up for SSA deduction and can provide copies of your statement showing premiums have been taken out of your check.
4. You can provide proof the address we have on file was not the current address during the coverage period for which you were enrolled.