WellCare Extra is a 2018 Medicare Prescription Drug Plan for Medicare beneficiaries in Rhode Island.
Be sure to have a look at the five most important components of the WellCare Extra plan before finalizing your 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 Extra is a cost sharing plan. There are three costs: monthly premiums, an annual deductible, and co-payments or co-insurance.
The annual premium is $782.40 ($65.20 per month), and breaks down like this:
You can't join the WellCare Extra plan if you have low income subsidy (LIS) benefits.
There is a $0.00 annual deductible with this PDP.
A zero dollar ($0.00) deductible, like this plan has, gives you first dollar coverage. Some PDPs have a deductible (up to $400 per year in 2018) that you must pay out-of-pocket before coverage begins.
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
There are two situations that change change what you pay. If you're accepted into the Extra Help program, administered by the Social Security Administration, your premium could be lower. It's also possible that your premium could be higher if you have a late entry penalty because you did not enroll when first eligible.
Details of Plan Coverage
WellCare Extra is a Enhanced 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
Confused about the initial coverage limit? Don't be, because it's straight forward. If you enroll in the WellCare Extra PDP, you share the cost of your prescriptions with WellCare. You each pay your share until the amount spent at the pharmacy reaches $3750.00. That's the initial coverage limit in Rhode Island for plan year 2018. After that you are not covered (coverage gap) until your actual out-of-pocket costs qualify you for catastrophic coverage. Keep reading, because you are entitled to automatic discounts.
Coverage Gap Phase
If you go into the coverage gap phase, commonly called the donut hole, you pay for your medications yourself. Most seniors never go into the coverage gap, but it's possible to hit it quickly if you have expensive long-term prescriptions. That's why it is so important to verify that the WellCare Extra plan offers your medications at the best price before you join.
In the coverage gap phase you are responsible for the full cost of your prescription drugs up until your total out-of-pocket expenses reach $4,550 (excluding premiums and expense paid by insurance) minus a 47.5% discount on brand-name prescription drugs and a 28% discount on generic drugs. Once you reach $4,550 in out-of-pocket expenses, you're out of the coverage gap. At this point you automatically get catastrophic coverage through Medicare, which assures you only pay a small amount for covered drugs for the remainder of the year.
Enhanced Gap Coverage
WellCare Extra 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
Once you've spent $4,950 out-of-pocket in 2018, you're out of the coverage gap phase. At this point, you automatically get "catastrophic coverage." This assures that you'll only pay a small co-insurance or co-payment for covered drugs for the remainder of the year.
Co-payment & Co-insurance Details
In addition to the monthly premium and annual deductible, the WellCare Extra 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 Extra 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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