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Conditions and Limitations

Here is some important information about our Prescription Drug Plans. Please make sure to read this section carefully to learn more about your prescription drug coverage.

  • WellCare (PDP) is a Medicare-approved Part D sponsor. Enrollment in WellCare (PDP) depends on contract renewal.
    • To be eligible, you must be eligible for Medicare Part A or enrolled in Medicare Part B. You must also live in the plan's service area.
    • Network pharmacies include retail, mail-service, specialty, long-term care, home infusion and Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) pharmacies. To obtain names and addresses of WellCare's network pharmacies, use the pharmacy search tool or call Customer Service.
    • You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances (e.g., emergencies) when you cannot reasonably use network pharmacies. Quantity limitations, prior authorizations, and restrictions may apply.
    • WellCare has a medication home delivery pharmacy that offers preferred cost sharing. At this pharmacy, you may get your drugs at a lower co-pay or coinsurance. You may go to any network pharmacy that offers standard cost sharing, but you may have to pay more for your prescription drugs.        
      • You can only be in one Medicare Prescription Drug Plan at a time. If you are currently in a Medicare Prescription Drug Plan, your enrollment in WellCare will end that enrollment. Enrollment in this plan is generally for the entire calendar year. Once you enroll, you may leave this plan or make changes only at certain times of the year when an enrollment period is available (example: you may make changes October 15-December 7 of every year), or under certain special circumstances.
      • If you are enrolled in a MA PFFS plan that includes Medicare prescription drugs or any MA coordinated care (HMO or PPO) plan, you will be automatically disenrolled from the HMO, PPO or MA PFFS plan if you enroll in a PDP.
      • If you are enrolled in a private-fee-for-service plan (PFFS) that does not include Medicare prescription drug coverage, an MA Medicare Savings Account (MSA) plan or an 1876 Cost plan, you may enroll in a PDP and will not be automatically disenrolled from the PFFS, MSA or 1876 Cost plan.
      • Members may enroll in the plan only during specific times of the year. Contact WellCare for more information.
      • If you qualify for additional assistance with your Medicare Prescription Drug Plan costs, the amount of your premium and cost at the pharmacy will be less. Once you have enrolled in WellCare, Medicare will tell us how much assistance you are receiving. WellCare will then notify you of the amount you will pay for your prescription drug costs.
      • If you decide to change your premium payment method, it could take up to three months for the change to take effect and you will remain responsible for premium payments during that time.
      • WellCare has a Failure to Pay (FTP) policy. If you do not make your premium payment for three months, you could be disenrolled in this plan.
      • By law, WellCare can choose not to renew our contract with CMS and CMS may also refuse to renew the contract, resulting in a termination or non-renewal. This may result in termination of your enrollment in the plan. Additionally, WellCare may reduce its service area and no longer offer services in the area where you reside.
      • This information is available for free in other languages. Please contact Customer Service.
      • Medicare beneficiaries may also enroll in WellCare through the CMS Medicare Online Enrollment Center, located at www.medicare.gov
      • This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
      • For full information on WellCare prescription drug benefits, please contact Customer Service.
      • Medicare rates how well plans perform in different categories (for example, quality and performance, customer service and patient safety). For more information, you can view our Star Ratings or visit www.medicare.gov to compare the Star Ratings for Medicare plans in your area. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
      • You must continue to pay your Medicare Part B premium.
      • You may contact 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week or visit www.medicare.gov for more information about Medicare benefits and services, including general information regarding the Part D benefit. TTY users can call 1-877-486-2048.


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Y0700_WCM_21424E Last Updated On: 10/1/2018