Wellcare is thankful for the opportunity to provide you with your Medicare Part D prescription drug benefit for 2026. As your prescription drug provider, it is our priority to ensure you have access to your medications.
Individuals enrolled in Medicare and Part D prescription drug plans may have an obligation to pay a plan premium and/or a Late Enrollment Penalty (LEP). Under Centers for Medicare and Medicaid (CMS) policies premium obligations can be paid by deduction from monthly retirement benefits.
Below are some helpful frequently asked questions about paying your premium using the Premium Withhold Option (PWO).
What is Premium Withhold Option (PWO)?
When you have a monthly premium and/or LEP to pay, Premium Withhold is one of several payment methods you can use. If you have Social Services (SSA) retirement benefits or Railroad Retirement Benefits (RRB), you may request that the monthly amount owed be deducted from your benefits account. SSA will send us the amount that you owe each month.
What is a Late Enrollment Penalty (LEP)?
For more information about LEP visit Wellcare.com/LEP.
Under Centers for Medicare and Medicaid (CMS) requirements, eligible Medicare members are required to have prescription drug coverage. When a beneficiary does not have acceptable coverage, CMS assesses the LEP, and we are required to include the LEP in your monthly premium charges. LEP does not end if you change plans.
A LEP is an amount added to your Medicare Part D monthly premium, as directed by CMS. The amount of the LEP depends on how long you went without Part D or creditable prescription drug coverage. Members may owe a Late Enrollment Penalty for any continuous period of 63 days or more after their Initial Enrollment Period is over, or go without one of the following:
- Medicare Prescription Drug Plan (Part D);
- A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage; or
- Creditable prescription drug coverage (current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, CHAMPVA, or health insurance coverage).
How do I request PWO?
The PWO method of payment may be requested when you enroll in one of our plans – the option is included on our enrollment application forms. If you are already a member, you may ask to switch to premium withhold at any time, by phoning Customer Services. We’ll send your request to CMS for approval, and in some cases, requests are denied. If your PWO request is not approved by CMS we will reset your payment method to direct bill, send you a new coupon book and you’ll have time to catch up on any missed payments.
When will the deductions begin?
Deductions always begin for a future coverage month, and the requests must be received approximately 25 days before the month you would like the PWO to begin. The premium charges are taken out of your SSA/RRB account before the coverage month that will be paid.
Sometimes the first two or three months will be charged when the PWO begins, but you will know the effective date for premium withhold before it starts. SSA/RRB will collect all owed premiums (for the months when the deduction was pending) in one lump sum. SSA/RRB will not deduct more than $300 at one time. After the initial payment your account will show one monthly amount deducted.
Do I have to keep paying Wellcare directly while I’m waiting for the SSA/RRB deductions to begin?
No. We don’t want you to double-pay your premium charges. We expect you to pay any premium charges that are due for coverage months before the effective starting date for SSA/RRB deductions. For example, if you enroll as of 1/1 and request premium withhold on 1/15, the PWO would take effect on 3/1 and you would be responsible to pay January and February premiums directly. The premium deduction would start for March.
If your PWO request is not approved by CMS we will reset your payment method to direct bill, send you a new coupon book and you’ll have time to catch up on any missed payments. Billing correspondence and requests for payment will not be sent to you while your PWO request is pending.
If you are not able to use SSA/RRB for your premium payments, we have other methods of payment that you could use instead of sending monthly checks in the mail. Other options include automated monthly payments from your credit card, debit card, checking account or savings account. More information will be included in the coupon book we send, and is available in the member portal.
My SSA/RRB payment was taken out of my account but the premiums still show as outstanding on my account. Why?
Premium charges are deducted from your SSA/RRB account in the month before the coverage month. CMS reports payments to us one per month, and we receive the payment report in the last week of the coverage month. This means that your payment will be posted in your account by the of the coverage month. If you are looking at your account in our secure member portal, checking the balance or payments by phone, or talking to a Customer Service Representative the payment is not yet visible.
This chart shows the timeline for SSA/RRB payments
I changed plans and my SSA/RRB deductions stopped. Why?
When you select SSA/RRB premium withholding for your method of payment, the request only applies to the plan that you were enrolled in when you asked for deductions. Any time that you change plans a new enrollment application is required, and you need to ask for PWO again for the new plan.
Why is the wrong amount deducted from my SSA or RRB account?
The deductions from your SSA or RRB account happen the month before the month for which the charge applies. You may have had a change in your billing amount because your level of Extra Help (Low Income Subsidy) changed, or your LEP amount changed. When the wrong amount is deducted SSA/RRB will process an adjustment to your account in a future month. Sometimes it may take up to 3 months for the updates to be completed.
Another reason for the wrong amount is that you may have changed plans or ended your plan with Wellcare. In these cases, the deduction may be for the month after your plan ends; the overpayment will be refunded to your SSA/RRB account, and not refunded by Wellcare.
Why did my deduction amount increase?
Your monthly premium change can increase if you lose your Extra Help, or the amount of the LEP that you pay may increase. LEP increases year to year, and when we get new information from CMS about gaps in your creditable prescription drug coverage.
Can I get a refund when PWO deducts too much?
If too much has been deducted from your SSA/RRB account, you are entitled to get a refund back to your account. CMS will issue you a refund.
If you have paid through PWO and have paid premiums directly to Wellcare, Wellcare will issue you a refund for the excess amount paid directly to us.
What if I no longer want to pay my premiums from my SSA or RRB account?
You may change your method of payment by calling Customer Service and asking that premium withholding from your SSA or RRB account be stopped. Please note that the request must be received approximately 25 days before the month that you want the change to become effective. For example, if you pay by premium deduction and want to have it stopped by May 1st, the request should be made before April 4th.
If I have questions, should I call SSA or CMS?
Our Customer Service representatives are able to answer most questions regarding the Premium Withhold Option, or get information for you from our subject matter experts. You may call SSA or CMS, but in many cases they will tell you to call your plan.
Have additional questions? We’re here to help!
You can chat live with a representative in our Member Portal or call us at 1-888-550-5252 (TTY: 711). Representatives are available to take your call Monday-Friday from 8 a.m. to 8 p.m. (Between October 1 and March 31, representatives are available Monday-Sunday, 8 a.m. to 8 p.m.).
