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Dual SNP Cost-Sharing Update

For Physicians Only:  Important information about the WellCare Liberty (HMO SNP) plan in New Jersey

WellCare of New Jersey would like to thank you, our contracted providers for your partnership, support and dedication in delivering the best health care to beneficiaries eligible for both our Medicare Advantage and Managed Medicaid Plans.

WellCare Liberty Medicare Advantage Plan (HMO SNP) is a Dual-Eligible Special Needs Plan SNP, which means only beneficiaries eligible for both Medicare and Medicaid may enroll in the plan. In addition, WellCare Liberty (HMO SNP) further qualifies as a Fully Integrated Dual Eligible (FIDE) SNP, which means that members receive both their Medicare benefits from the plan and their full Medicaid benefits – including, when eligible, Long Term Services and Supports.

As a FIDE (SNP) Special Needs Plan, WellCare Liberty (HMO SNP) is a zero cost-share plan. This means members, so long as they are active with the plan, owe nothing for covered services and may not be balance-billed for covered services. Claims for WellCare Liberty members will be adjudicated first through their Medicare benefits and then through their Medicaid benefits. Services not covered by Medicare may in turn be covered by the members’ Medicaid benefits. This includes cost shares (i.e., deductibles, co-payments and coinsurance) for Medicare-covered services.

LIBERTY MEMBERS ARE NOT RESPONSIBLE FOR MEDICARE COST SHARES

Therefore, although member deductibles, co-payments or coinsurance may appear on your Explanations of Payment (EOPs) or Remittance Advices (RAs), those amounts may not be billed to plan members. WellCare Liberty (HMO SNP) members are cost share protected by the State, which means they must not be billed. Instead, the Medicare cost shares will be adjudicated through the members’ Medicaid benefits to determine what, if anything, is still owed by the plan. WellCare payment for covered services for which the members’ Medicare benefit is primary must be considered payment in full and will be the lesser of the Medicare or Medicaid Allowable Amounts.

LIBERTY MEMBERS’ IDENTIFICATION CARD

WellCare Liberty (HMO SNP) members should have a plan identification card like the one shown below. This single card gives members access to all of their plan benefits, which include not only their Medicare benefits but also their full Medicaid benefits – including, when eligible, Long Term Services and Supports. You can also log on to WellCare’s Provider Portal to check member benefits and eligibility at provider.wellcare.com.

NJ DSNP Cost Share

If you have questions about WellCare’s DSNP plans or the information in this communication, you may consult our Medicare Advantage Provider Manual, call Provider Services at 1-855-538-0454 or contact your local WellCare Provider Relations Department.

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Last Updated On: 6/19/2018
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