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Medicare : Conditions

Here is some important information about our Medicare Advantage Plans. Please make sure to read this section carefully to learn more about your Medicare Advantage coverage.


  • WellCare (HMO) is a Medicare Advantage organization with a Medicare contract. Enrollment in WellCare (HMO) depends on contract renewal.
  • To be eligible, you must be enrolled in Medicare parts A and B and must 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 contact us.
  • 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 and restrictions may apply.
  • Non-Point-of-Service Plans: You must use plan providers except in emergency or urgent care situations or for out-of area renal dialysis. If you obtain routine care from out-of-network providers, neither Medicare nor WellCare will be responsible for the costs.
  • Point-of-Service Plans: With the exception of emergencies, urgent care and out-of-area renal dialysis, it may cost more to get care from out-of network providers.
  • You can only be in one Medicare Advantage Plan at a time. If you are currently in a Medicare Advantage or Prescription Drug Plan, your enrollment in WellCare will end that enrollment. Enrollment in this plan is generally for the entire 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 have qualified 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, and we will send you information on the amount you will pay.
  • If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for it to take effect and you will remain responsible for payment of those premiums.
  • 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 our Customer Service.
  • Medicare beneficiaries may also enroll in WellCare through the CMS Medicare Online Enrollment Center, located at
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, co-payments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/coinsurance may change on January 1 of each year.
  • For full information on WellCare Medicare Advantage Plan benefits, contact us.
  • The Medicare program rates how well plans perform in different categories (for example, detecting and preventing illness, ratings from patients and customer service). For more information, you can view our Star Ratings or visit 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, 7 days a week or visit for more information about Medicare benefits and services, including general information regarding the Part D benefit. TTY users can call 1-877-486-2048.

Y0070_NA027269_WCM_WEB_ENG CMS Approved

Last modified: 10/02/2014

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