The Coverage Gap for 2012

The bottom line on the Coverage Gap.

After you and/or others on your behalf have spent a certain amount on prescriptions ($2,930 also known as the initial coverage limit), your PDP coverage will change.

You enter the gap. You pay 86% coinsurance on generic drugs and 50% on brand drugs until your out-of-pocket costs reach $4,700.

After your out-of-pocket costs reach $4,700 (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 you pay the greater of 5% of the cost of drugs OR $2.60 for generic drugs and $6.50 for brand drugs until the end of the calendar year.

WellCare's preferred 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 preferred generic drugs in our WellCare Signature (PDP) and $0 co-pays on preferred generic drugs in our WellCare Classic (PDP) in most regions. 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.  Also, you can use our Preferred Mail-Order Pharmacy which will save you money and deliver directly to your door!

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

$4,700	Catastrophic Coverage	Catastrophic Coverage begins when your out-of-pocket costs reach $4,700. For the rest of the year, you pay the greater of 5% of the cost of drugs OR $2.60 for generic drugs and $6.50 for brand drugs until the end of the calendar year.
$2,930	Coverage Gap	Coverage Gap starts when you and/or others on your behalf have spent $2,930 on drugs. You pay 86% coinsurance on generic drugs and 50% on brand drugs until your out-of-pocket costs reach $4,700
$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 preferred generic drugs in the WellCare Signature (PDP) plan) until you and/or others on your behalf have spent $2,930.

WellCare helps you keep track of the gap.

At WellCare, we send you an Explanation of Benefits (EOB)  that tracks your spending and ours—so you always where you are at with your drug spend to see how close you are to the coverage gap. That way, there are no surprises and you can budget accordingly. You will receive a monthly EOB ONLY if you fill a prescription that month.