WellCare Classic, KY 2013 PDP
|Initial Coverage Limit:||$2,970.00|
|Gap Coverage:||No Gap Coverage|
|$0 Premium LIS Benefit:||No|
|Drugs in Formulary:||2506|
|Drug Plan ID:||S5967-152|
|CMS Approved for:||KY Residents|
|Members in Region:||19119|
PDP Plan Highlights
KY WellCare Classic (PDP) is a Medicare prescription drug plan underwritten by WellCare for eligible residents of Kentucky. The plan is approved by CMS for drug formulary 00012170, which has 2506 FDA approved medications. The monthly premium is $39.50 ($474.00 for a full 12 months) and the pharmacy deductible is $0.00 per year. That means you receive prescription coverage assistance on day one (first dollar coverage).
Kentucky seniors, be aware that a few different circumstances may decrease or increase your actual premium. Specifically, if you qualify for Extra Help (full or partial), your premium will decrease. On the other hand, if you have a premium penalty, your premium will be slightly more.
WellCare Classic Initial Coverage Phase
The Initial Coverage Phase (ICP) is your plan’s cost-sharing phase. During the ICP both you and your insurance provider share the cost of your prescription medications. This plan has no deductible so your initial coverage phase begins immediately.
Each medication is put into a tier within the plan’s formulary. This is simply a way for the insurer to manage cost-sharing. It’s important to note that every plan can put medications on any tier they deem suitable. This is not standardized, because it is based on cost and the various risk models used by the insurers.
The tiered prescription cost sharing (e.g., pharmacy co-pay) in Kentucky with this plan is as follows:
|Tier||Co-Pay Amount||Medications in Tier|
|1||$0.00||785 Preferred Generics|
|2||$43.00||954 Non-Preferred Generics|
|3||$95.00||543 Preferred Brand Drugs|
|4||25%||224 Non-Preferred Brand Drugs|
|5||0 Specialty Drugs|
The 2012 Initial Coverage Limit with WellCare Classic is $2,970.00. This drug plan doesn't qualify for a no cost LIS premium.
Coverage Gap Phase
The Coverage Gap, also known as the Donut Hole is the phase of your Part D plan where you must pay all of your medication costs. Healthcare Reform offers some additional assistance. For 2012 your insurance carrier will pay 7% of your generic drug prescription costs for you while you are in the donut hole. Likewise, the brand-name drug pharmaceutical companies cover half (50%) of your brand-name drug prescription costs. These subsidies count toward your True Out of Pocket (TrOOP) costs.
Some Medicare Part D plans provide additional Coverage Gap assistance that covers you above and beyond the discounts mandated by the Healthcare Reform Act. It’s important to note that if you have prescriptions that are not covered under your plan’s Gap Coverage, you will still get the generic and brand name drug discounts listed above, even if the plan itself does not offer gap coverage.
Here's how the carrier defines the 'donut hole' gap coverage for this policy: You must pay the $3727.50.
The number of Medicare recipients using the WellCare Classic plan nationally is 684,426. In your area (CMS PDP region 15) there are a reported 19,119 seniors on this plan. That's based on the previous year's reporting information.
Facts About WellCare
WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of health plans for families; children; and the aged, blind and disabled; as well as prescription drug plans. The company served approximately 2.4 million members nationwide as of June 30, 2011.
Essential Information About Medicare Part D
Pharmacy agreements are unique with each prescription drug plan. Many plans include stringent geographic limits, such as state borders, whilst some supply nationwide drugstore coverage. Should you have an active lifestyle which often consists of frequent traveling, it may help you to have a policy that permits you to use drug stores in all states.
Medicare Part D plans have a specified service area. It's the area where the provider does business. To enroll, you must reside in the plan’s services area. Remember that many providers offer mail-order solutions. This way it's possible to have your prescription drugs shipped directly to your residence. Your representative will assist you to select a plan that suits what you need, so don’t hesitate to simply call and ask.
Each health care insurance company sets their own prices. Payments for prescription drug plans can vary quite a bit, even to get similar coverage, so it pays to look prior to choosing.
Insurance providers announce new prices and other premium information each October. Make sure to take a look at and assess premiums each year just before open enrollment.
Be aware that if you do not register for a Medicare Part D insurance plan as soon as you are eligible, your future payments could be higher. This late entry penalty is set by Medicare, not the insurance providers. Every month you delay after eligibility you will pay an additional 1% per month permanently.