WellCare Classic is a 2018 prescription drug plan (PDP) that's available to people in Rhode Island with Medicare benefits.
There are five components of every plan that should be evaluated before making an enrollment decision:
- Premium & Deductible: The premium is the amount you pay to be in the plan. This is the monthly cost of membership. In addition, plans may have an annual deductible. This is an amount that you pay towards your prescription costs before cost sharing begins.
- Co-pays & Co-insurance: This is where many people pay more than they should. Prescription co-payments (what you pay at the pharmacy) vary widely based on the formulary tier your drug is in. It's critical to verify that your medications are covered at the lowest tier possible.
- Coverage Phases: All Medicare Part D plans have an initial coverage phase, followed by a coverage gap phase, followed by a catastrophic coverage phase. The phase you're in will largely depend on the cost of your prescriptions. Some plans offer additional coverage in the gap phase. If you have costly medications, look for a plan with additional gap coverage.
- Medication Cost: One of the most challenging aspects of the Medicare Part D program is finding your prescription at the best price. It has as much to do with the pharmacy you use as it does the plan itself. This is because plans have preferred pharmacies and pharmacies have different contracts with pharmaceutical manufactures. Here's a secret, use our friends at GoodRx.com to find your prescription at the best price in your town.
- 5-Star Ratings: Critical measurements, by Medicare, will help you see how well this plan will care for you.
Detailed Cost Information
WellCare Classic is a cost sharing plan. There are three costs: monthly premiums, an annual deductible, and co-payments or co-insurance.
The annual premium is $391.20 ($32.60 per month), and breaks down like this:
The WellCare Classic plan qualifies for low income subsidies. The following table shows the subsidised premiums:
|Subsidy Level||Monthly Premium|
There is a $405.00 annual deductible with this PDP.
The Part D deductible is capped at $405 (2018 level). A plan with the maximum deductible is not always more expensive than a similar plan with a lower deductible. You must factor in all costs (premium, deductible, co-pay and pharmacy price).
Your Out-of-Pocket Costs: Premium + Deductible + Co-pay
Be aware that you must continue to pay your monthly premium even when you are not using any medications. Also, it's important to plan ahead because you are responsible for one hundred percent of your prescription costs until the plan's deductible has been met. You must also make the required co-payment when you pickup your prescriptions. These are your share of the prescription drug costs. The plan pays the rest until you reach the coverage gap (aka, “donut hole”).
Your Costs May Be Different
Most people pay the standard premium. However, if you get Extra Help from Social Security, due to your income, your premium will be less. That's one situation. The other is a penalty for not enrolling on-time. In this case, Medicare can impose a penalty and your premium will be higher.
Details of Plan Coverage
WellCare Classic is a Basic Alternative plan. By law, WellCare is required to offer a standard benefit package. The standard benefit has an annual deductible, an initial coverage limit, a gap in coverage (donut hole), and a catastrophic coverage phase. Insurance carriers have the option to offer plans that:
- are an actuarial equivalent to the standard benefit; or
- provide enhanced benefits, as compared to the standard benefit.
Most enhanced plans provide additional coverage in the coverage gap phase. If your medications are costly, shop and compare enhanced plans.
Initial Coverage Limit Phase
The ICL is the same for all Rhode Island plans, but it changes from year-to-year. If you enroll in WellCare Classic you share the cost of all covered medications with WellCare. You each pay your share until $3750.00 has been spent at the pharmacy. If you reach that level of spending on your prescriptions then you fall into the dreaded coverage gap and you are responsible for all costs. Fortunately, automatic discounts kick in to help you until you qualify for Medicare's catastrophic coverage in Rhode Island.
Coverage Gap Phase
If you reach the coverage gap phase, or donut hole, as many people call it, you are essentially uninsured and must pay for all of your prescription costs out-of-pocket. When you reach the coverage gap with the WellCare Classic plan will all depend on your prescriptions. Most people never exceed the ICL and don't have to worry about it. If you are on a long-term medication that's costly, you could reach the donut hole very quickly.
If you reach the ICL (most seniors don't), then you are responsible for 100% of your prescription costs until your out-of-pocket costs hit $4,550 (excluding your monthly premiums and the amount paid by the plan). This is called the coverage gap or donut hole. The good news is that you get a 47.5% discount on brand-name prescription drugs and a 28% discount on generic drugs while you're in the gap. You get to the other side of the donut hole when you've spent $4,550, at which point you automatically qualify to receive catastrophic coverage from Medicare.
Enhanced Gap Coverage
WellCare Classic does not offer coverage gap assistance. If went into the coverage gap phase last year, and you were unable to afford your prescriptions, call your local Rhode Island Medicaid office about assistance. The Extra Help program, from the Social Security Administration, may also be available to help you afford your medications.
Catastrophic Coverage Phase
The final phase is catastrophic coverage. You reach this phase once you've spent $4,950 out-of-pocket. With catastrophic coverage you pay a small co-insurance or co-payment on your covered medication for the remainder of the year.
Co-payment & Co-insurance Details
In addition to the monthly premium and annual deductible, the WellCare Classic prescription drug plan has co-payments (fixed dollar amount) and/or co-insurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
|Tier||You Pay||Tier Description|
CRITICAL: To understand how much you will pay at the pharmacy if you join this plan, you must find the tier of each of your prescriptions in the plan's formulary.
TIP: Use the GoodRx Medicare tools to find your prescription at the best price in your town.
CMS 5-Star Ratings
The annual CMS plan ratings are important. Each year CMS rates PDPs across four categories. Ratings offer a good clue as to the quality of service you can expect if you join the plan.
|2018 Overall Rating|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
WellCare Contact Information
Here's the new member contact information for WellCare:
For assistance 24 hours a day, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048 or visit www.medicare.gov
If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the WellCare Classic prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Cranston, Providence, Warwick, Pawtucket, Woonsocket, Coventry, and all other towns and cities in Rhode Island.
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