Medicare Basics

Disclaimers

Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc.

Texas Residents: Wellcare (HMO and HMO SNP) includes products that are underwritten by WellCare of Texas, Inc., WellCare National Health Insurance Company, and SelectCare of Texas, Inc.

Washington residents: “Wellcare" is issued by WellCare Health Insurance Company of Washington, Inc.

Wellcare Dual Liberty (HMO D-SNP) Members: Wellcare Dual Liberty (HMO D-SNP) is a Fully Integrated Dual Eligible Special Needs Plan with a Medicare contract and a contract with the New Jersey Medicaid program. Enrollment in Wellcare Dual Liberty depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations and restrictions may apply. Benefits may change on January 1 of each year. Your Part B premium is covered by Medicaid. This plan is available to those who have both Medicare and full Medicaid benefits. Wellcare uses a formulary. Please contact Wellcare for details.

Every year, Medicare evaluates plans based on a 5-star rating system.

Louisiana D-SNP members: As a WellCare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through WellCare and are also eligible to receive additional health care services and coverage through Louisiana Medicaid. Learn more about providers who participate in Louisiana Medicaid by visiting myplan.healthy.la.gov/en/find-provider. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at ldh.la.gov/medicaid and select the “Learn about Medicaid Services” link.

Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at ldh.la.gov/medicaid.

Notice: TennCare is not responsible for payment for these benefits, except for appropriate cost sharing amounts. TennCare is not responsible for guaranteeing the availability or quality of these benefits. Any benefits above and beyond traditional Medicare benefits are applicable to Wellcare Medicare Advantage only and do not indicate increased Medicaid benefits.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Wellcare's pharmacy network includes limited lower-cost, preferred pharmacies in rural areas of LA, MO, and NE. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-833-444-9088 (TTY 711) for Wellcare No Premium (HMO) in LA or consult the online pharmacy directory at www.wellcare.com/medicare; and 1-833-444-9088 (TTY 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), and Wellcare Assist (HMO) in MO or consult the online pharmacy directory at www.wellcare.com/medicare; and 1-833-542-0693 (TTY 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), Wellcare No Premium Open (PPO), and Wellcare Assist Open (PPO) in NE or consult the online pharmacy directory at www.wellcarene.com.

Value-Added Items and Services (VAIS) are not plan benefits and are not covered by the plan. Plan enrollees are responsible for all costs.

Please contact your plan for details.

Grievances

You have the right to file a grievance or provide feedback directly to Medicare about our plan. Complete and submit the Medicare Feedback and Complaint Form.

Medicare has an Office of the Medicare Ombudsman (OMO) that can help you with complaints, grievances and information requests. Visit Medicare.gov for more information about Medicare and/or assistance with complaints and grievances.

How to access coverage in the event of a disaster or local emergency.

In the event of an emergency or natural disaster, Wellcare is committed to helping you continue to access care easily. In a time of crisis, we will:

• Allow Part A and Part B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities (note that Part A and Part B benefits must, per 42 CFR §422.204(b)(3), be furnished at Medicare certified facilities)
• Waive in full, requirements for gatekeeper referrals where applicable
• Temporarily reduce plan-approved out-of-network cost-sharing to in-network cost sharing amounts
• Waive the 30-day notification requirement to enrollees as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the enrollee

• Allow you to fill medications sooner than usual to ensure you have what you need during the emergency 

These actions will be in effect through the emergency declaration period. Disasters/Emergencies may be declared by the U.S. Government, the Federal Emergency Management Agency (FEMA), or the Governor of any state.

Typically, the source which declares the disaster will clarify when the disaster or emergency is over. If however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if the Centers for Medicare & Medicaid Services (CMS) has not indicated an end date to the disaster or emergency, we will resume normal operations 30 days from the initial declaration.