WellCare Extra, CA 2013 PDP
|Initial Coverage Limit:||$2,970.00|
|Gap Coverage:||Many Generics|
|$0 Premium LIS Benefit:||No|
|Drugs in Formulary:||0|
|Drug Plan ID:||S5967-203|
|CMS Approved for:||CA Residents|
|Members in Region:||0|
PDP Plan Highlights
CA WellCare Extra (PDP) is a Medicare prescription drug plan underwritten by WellCare for eligible residents of California. The plan is approved by CMS for drug formulary UNKNOWN, which has 0 FDA approved medications. The monthly premium is $49.00 ($588.00 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).
California 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 Extra 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 California with this plan is as follows:
|Tier||Co-Pay Amount||Medications in Tier|
|1||0 Preferred Generics|
|2||0 Non-Preferred Generics|
|3||0 Preferred Brand Drugs|
|4||0 Non-Preferred Brand Drugs|
|5||0 Specialty Drugs|
The 2012 Initial Coverage Limit with WellCare Extra 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: 65% to 100% of formulary generics are covered, but you must pay for Brand Drugs up to $3727.50.
The number of Medicare recipients using the WellCare Extra plan nationally is 0. In your area (CMS PDP region 32) there are a reported 0 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
Pharmacist contracts are unique with each drug program. Certain programs have strict regional limitations, such as state boundaries, while some supply national coverage. Should you have an active personal life that consists of regular traveling, it's going to assist you to have a policy that permits you to use pharmacies in all states.
Medicare Part D plans have a specified service area. This is the area in which the provider does business. To enroll, you must reside in the plan’s provider area. Bear in mind that nearly all providers offer mail-order services. This way you can have your medications sent straight to your residence. Your representative can assist you to select a program that meets what you need, so don’t hesitate to simply call and ask.
Each medical insurance provider sets its own prices. Prices pertaining to health professional prescribed drug plans can vary widely, even to get equivalent coverage, so it will pay you to shop before you choose.
Insurance companies announce new fees as well as other premium information each October. You'll want to check and compare rates every year prior to open enrollment.
Please remember if you don't register for a Medicare Part D insurance policy once you first are eligible, your long term payments will be higher. This late entry penalty is established by Medicare, not the insurance plan suppliers. Every month you delay following eligibility you will pay an additional 1% each month forever.