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Wellcare for Part D by Andrew Forsythe

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AUTHOR: Andrew Forsythe on 10/07/2024

For us Medicare types, it’s that Part D time of year again. In mid-September I received an email from our Part D insurer, Aetna Silverscript, saying I could see the Annual Notice of Change online. I did so and got a shock. My wife’s and my monthly premiums were going from $9.80 each to $44.80 each beginning in January 2025.

I did a little reading online, and contacted our broker, and learned that due to some recent legislation Part D plans were in for some big changes in 2025. Tell me about it.

The next step was on October 1st, when all the available Part D plans in our area for 2025 would be listed on the Medicare website. On that day I had a look. The website is quite useful—you can enter all the prescription drugs you take and it will save that information and use it to give you a total annual cost (premiums plus drug costs) for each Part D plan offered.

I saw that, for my wife and myself, our combined total annual cost if we stayed with Aetna Silverscript would increase from $274.46 in 2024 to $1353.84 in 2025. A bitter pill to swallow.

But there were a few Part D plans offered with lower costs, and the least expensive by far were a couple from Wellcare. In fact, the cheapest plan, the Wellcare Value Script, would actually reduce our combined yearly cost to $116.80. The other Wellcare plan, Wellcare Classic, would increase it a bit to $414.63.

I also ran the numbers if we used GoodRx for the drugs when its prices were lower than what they would cost with the insurance. This lowered the total annual cost amounts substantially in some cases. For example, with the Wellcare Value Script plan, our combined total annual cost would go from the already bargain rate of $116.80 to an almost unbelievable $40.19. You would likely see similar savings with SingleCare or Mark Cuban’s CostPlus Drug Co.

So this is all leading up to my question: Do any of my fellow HD readers and writers use Wellcare for their Part D plan? If so, what’s been your experience? I’ve actually read a few good reviews, several saying they’ve greatly improved customer service in recent years. I spent a few minutes on their website, double checking the numbers I’d gotten on the Medicare site, and found it quite user friendly. But that old saying “If it seems too good to be true it probably is” keeps banging around my head.

A couple of final comments. As my fellow Part D participants probably know, the Annual Enrollment Period, when you can change your plan, is from Oct. 15th to December 7th. I’ve also read that the insurer information and cost figures on the Medicare website are sometimes updated by the companies after October 1st. So  some folks say they check back in early November.

I’d appreciate any comments from those with recent experience with Wellcare. Thanks.

 

 

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Jerry Granderson
3 months ago

My wife and I have been on the Wellcare plan in 2023 & 2024. In 2024 premium was $0. Out of pocket has been minimal. My wife is on 1 med and I am on 4. Two of mine also have no cost when I fill them at our local Costco under the Wellcare plan. Very happy with it.

Hector Guenther
3 months ago

Hi all. Lots of changes in Part D premiums, co-pays, etc. are principally due to Medicare’s instituting of a new yearly out-of-pocket maximum of $2,000. One should check his/her drug plan every year during Open Enrollment Oct. 15-Dec. 7. As for using brokers (a.k.a. commissioned salespeople) – a better option might be to find a SHIP volunteer Medicare counselor in your community. Volunteers have no financial incentive to steer you one way or another. Go to https://www.shiphelp.org/about-medicare/regional-ship-location

William Dorner
3 months ago

This is a very interesting subject. I have a question. What happens if you pay for Medicare part D to the Government, but do not say buy a Wellness plan. We have to pay twice, once to Medicare and again to a company like wellness to get any drug relief. There are many twists and turns. My United Healthcare via AARP went from $25 in 2023 to $50 in 2024 and wants to go to 92 in 2025??? Can anyone help make some comments. All I can think of is to go to a different plan that is lower in price and hope for the best.

mytimetotravel
3 months ago
Reply to  William Dorner

Are you referring to a deduction from your Social Security check for Part D? If so, that is IRMAA – a surcharge for high income retirees with Part D plans. It does not buy you any coverage.

The usual recommendation is to buy the cheapest plan that covers the drugs you take. Of course, that doesn’t help if your needs change during the year, or if the plan changes its list of covered drugs. I recommend reading “Medicare for Dummies” and meeting with a SHIP counselor.

David Lancaster
3 months ago
Reply to  William Dorner

The payments you make to the government are part B pays for coverage of MD visits, outpatient visits, and durable medical equipment.

The part D premiums are for your medications.

It’s recommended that you go to the Medicare website and enter your medications before you search for plans as this will then provide information as to what is the best coverage for your individual needs the upcoming year. This activity should be performed every fall during open enrollment as the formularies change frequently as well as the premiums.

If you drop your part D coverage and the want to re-enroll you will pay a penalty for the rest of your life.

Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($34.70 in 2024) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly penalty is rounded to the nearest $. 10 and added to your monthly Part D premium.

Last edited 3 months ago by David Lancaster
William Dorner
3 months ago

Thanks for the replies. I understand all of the above. Part D is $12.90 per month, if you get nothing else what does this cover. Say I do not get Wellness or any other like insurance. What does Part D only Medicare get you?

Last edited 3 months ago by William Dorner
parkslope
3 months ago
Reply to  William Dorner

“You pay your Part D IRMAA directly to Medicare, not to your plan or employer.
You’re required to pay the Part D IRMAA, even if your employer or a third party (like a teacher’s union or a retirement system) pays for your Part D plan premiums. If you don’t pay the Part D IRMAA and get disenrolled, you may also lose your retirement coverage and you may not be able to get it back.”
https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/monthly-premium-for-drug-plans

mytimetotravel
3 months ago
Reply to  William Dorner

I see you edited your post. If $12.90 is being deducted it is the IRMAA surcharge. If you don’t want to use the link I posted, look it up yourself. There are multiple articles on this site alone on IRMAA. It is not your premium, which presumably you are paying directly to the insurance company. It is not buying you any coverage. You are paying it because your income two years ago was over a certain amount.

mytimetotravel
3 months ago
Reply to  William Dorner

There is no such thing as “Part D only Medicare”. If the deduction is $12.19 that is the premium you are paying for whatever Part D plan you chose during last year’s open enrollment period. If it were $12.90 it would be an IRMAA surcharge. The Part D premium can be paid directly to the insurance company or deducted from your Social Security. I have done it both ways. Please read the book I recommended. Also look at the Social Security statement you received towards the end of 2023.

David Lancaster
3 months ago
Reply to  mytimetotravel

I second the book recommendation. Patricia Barry’s book is very clear, concise, and written with basic language.

I have utilized to make decisions for my wife and I. I even recently corrected an enrolled agent at BC/BS regarding the ability to switch from a Medicare Advantage to traditional Medicare with a Part D in the first year with guaranteed issue.

Unfortunately he did not know that if we decided to apply this month, effective 12/1 that Medicare would consider the Part D to be double Rx coverage as you can only sign up for Part D one month in advance.

We learned this when we received notification from the Advantage Plan that Medicare was changing the effective date to 11/1. This resulted in having to call BC/BS to cancel the Rx coverage which will reinstate the Advantage Plan to 11/31. We have to wait until November to sign up for the Rx plan.

This is a long winded post to show how convoluted the entire Medicare process is.

This mess was all created because Medicare will not allow you to sign up for a Rx plan until 1 month in advance. RIDICULOUS,

Last edited 3 months ago by David Lancaster
mytimetotravel
3 months ago

Unless you are exercising your Guaranteed Issue right you can only pick a new Part D plan during the open enrollment period at the end of the year and it will be effective January 1st of the new year. This is unfortunate if your drug needs change during the year…..

I agree that Guaranteed Issue is little known.

Mark Hirsch
3 months ago

My wife has had Wellcare for two years; I have had it for one. This year the cost has been zero for both of us. We get three scrips filled monthly between the two of us. There are a few more, maybe half a dozen, over the year. Luckily nothing in higher drug tiers. They push to have you use their mail plan. It can be annoying but we continue to use our local pharmacy without any problems. Yep. Price is amazing. I should mention that they were recommended by a consultant

Liz Brennon
3 months ago

I think a lot of companies are counting on people not checking D prices each year. Last year my AARP United Health Care premiums more than doubled and with the same drugs added around $900 to my annual costs. I switched. Good thing I checked. Get everyone you know to check each year.

I too worry that the Wellcare might have a hidden issue/catch. Sure it is cheapest for me putting in the drugs I am taking now – but we don’t have ESP to know what drugs we will need in the future. And by law they can change the formulary any time they want starting Feb of each year. Of course doing that in a major way would likely come back to haunt them as word got around.

Also some hospitals have special pricing on their drugs in some of their pharmacies (I don’t remember what the program is called) where you can’t use your insurance but the prices are amazingly low – beating insurance and coupons. I have used that on occasion (but watch the price of parking as that may drive the price up over the drugstore cost).

And at least it used to be the case, haven’t checked yet this year, that if you turn in your receipts for Rx’ed drugs to your D plan they have to credit your deductible. As a result if that is continuing next year then that if coupons are cheaper than full price during the deductible it would make sense to go that route.

judy f
3 months ago

JUDY F. My husband and I have had Wellcare for several years, never really had an issue, he’s always opted for the least expensive plan because he doesn’t take any prescriptions. I take 4 different scripts, 0ur premiums both dropped last year to 0.00 thats zero!!! & 0.00 copay for my 3mo supply of all generics. when I asked my insurance agent to double check the info. it was correct, haven’t looked at this yrs. yet. I’m actually afraid to. Could it be tooo good to be true

Mark Eckman
3 months ago

Go to Medicare.gov and follow the links to find a Medicare part D plan. After you input your prescriptions and pharmacies, it will present your current plan followed by the plans available in your zip code in the order of total cost.

That is, the cost of the drugs, plus the premium paid, and recognizing the deductible and out of pocket costs. This allows you to compare the plan details and evaluate what you will pay in total for the year.

Note, open enrollment for 2025 starts October 15, 2024, so the software is not yet final. Rely on the data only after October 15, 2024.

Harold Tynes
3 months ago

I met with my broker this morning and found some good news. I will be going back to AARP United next year. The math is interesting. Wellcare monthly premium is 0, Deductible is $590, Total Annual Cost (Premium + meds) is $1940.60.

AARP United monthly premium is $86.40, Deductible is 0, Total Annual Cost (Premium + meds) is $1289.00.

Save over $650 by moving back to AARP United. Mail order is Optum and pharmacy is Walgreens with new plan.

I would say if you have minimal drug cost the Wellcare should be fine.

William Dorner
3 months ago
Reply to  Harold Tynes

Hi Harold, please explain your math. $86.40 for AARP is $1036.80 per year so your drugs are for AARP $1289 less $1036.80 or $252.20. If for Wellcare your total was $1940.60 that was your drug cost, right. Help me here. Thanks. Bill

Harold Tynes
4 months ago

I shop Part D every year with the help of a broker. I moved last year from AARP United to Wellcare Part D. It saved me about $1000 at the time. My interactions with Wellcare have been minimal as most of the interaction is with their pharmacies: Express Scripts (mail order) and Walgreen’s/CVS . I take 5 prescription meds including the very expensive Trulicity. My advice is there is work involved in making these changes and you can’t start until January 1. The prescriptions at United were not moved over to Wellcare and I had to have my doctor issue new scripts for all. Make sure you have enough meds on hand to get you through the start up. I had some issues with Express Scripts in that their default is to ship meds immediately after receipt of a script. I finally got that under control so I could have meds delivered when I needed them.
Wellcare will probably be the winner in this year’s contest but I have a meeting with my broker tomorrow.
Good luck!

Robert Wright
4 months ago

I know the HD community is sour on Medicare Advantage plans but they have worked for me. Zero deductible for prescriptions and zero premium. Generics are zero copay. Zero premium for medical, doctors are in plan both in NY and SC (snowbird).

GaryW
3 months ago
Reply to  Robert Wright

I live in the Rochester NY area, the healthcare market here is dominated by 3 non-profits. Excellus has the bulk of the health insurance, by some estimates 73%. Two healthcare networks (one run by the University of Rochester Medical Center) run all the hospitals in the region and many of the other medical facilities between them.

Is that a good thing? I’ll let others debate that. However, it means everybody is forced to work together. My Medicare Advantage plan from Excellus includes all the hospitals in the region and 99% of the physicians. I don’t need to get referrals for specialists or even need to designate a primary care physician.

mytimetotravel
4 months ago
Reply to  Robert Wright

Most MA plans probably work well, until they don’t. And then you’re stuck, unless you can pass medical underwriting. Given the plan is probably no longer working for you because you are sick, you’ll most likely fail.

Last edited 4 months ago by mytimetotravel
Robert Wright
3 months ago
Reply to  mytimetotravel

I have to disagree. By law, MA plans have to follow the same requirements as original Medicare. It’s just that the private sector (insurance companies) is able to do it less expensively than the public sector (government). No surprise there.

R Quinn
3 months ago
Reply to  Robert Wright

Not true. MA Plans operate like a HMO or PPO the very type of plan employees complain about from employers with limited networks, precertification, and medical necessity review.

There is no logical reason they are able to provide all they claim except they are overpaid by Medicare and limit their claim expenses.

They can’t do it less expensively unless they don’t do it. Only Medicaid pays less for health care services than Medicare

Yes, MA works until it doesn’t. Many plans and the concept are under investigation currently and many are cutting back on their services for 2025.

mytimetotravel
3 months ago
Reply to  Robert Wright

Actually, MA plans cost the government more than regular Medicare. And you are limited to doctors and hospitals that accept your plan, and treatment that the plan will authorize.

Robert Wright
3 months ago
Reply to  mytimetotravel

I researched it and you are correct that MA cost the government (taxpayers) more than original Medicare. But then again Medicare Advantage plans offer so much more than original Medicare including coverage for eye exams as well as generous dental benefits. You are not limited in an MA plan to only network providers, you can always go out of network and assume a higher copay. Just as all doctors are not required to accept original Medicare, similarly all doctors are not required to participate in an MA plan. It’s suicide to have original Medicare without an expensive Medigap policy to pick up all or part of the 20% that original Medicare typically doesn’t pay. A $200,000 surgery could have you on the hook for $40,000 without Medigap. MA plans are typically capped at $6,000 -$8,000 maximum out of pocket.

David Lancaster
3 months ago
Reply to  Robert Wright

The dental benefit of Medicare Advantage is not as significant as one would think.

This year my wife has a Medicare Advantage plan until she switches to traditional within the first year (which supplement plans are required issue at the same premium as if she obtained the supplement plan when she was first eligible).

We go to the same dentist and I, who now have traditional Medicare paid $121 for a cleaning. My wife had to pay a $50 copay, so the difference for the year is a whole $142.

Regarding the eye exam coverage I last paid $100 for a routine eye exam, and I’m sure if my wife were to go she would have the same copay as for dental. Medical procedures for eyes (such as surgery for cataracts) are covered under traditional as well. With plan G this surgery would entail no out of pocket expenses.

Last edited 3 months ago by David Lancaster
mytimetotravel
3 months ago
Reply to  Robert Wright

Of course you don’t want Medicare without Medigap. Whether you can go out of network, and how much it will cost you, depends entirely on your plan and the doctors you want to see. Large hospital networks in my area have at least twice waited until the last moment to agree terms with United Health MA plans, which is a lot of stress for people. One day there may be no agreement.

Robert Wright
3 months ago
Reply to  Robert Wright

$6,000 – $8,000 MA out of pocket cap is for the year, not per procedure.

jerry pinkard
4 months ago

My wife uses Wellcare Value Script. She only has 3 prescriptions. There is no monthly premium and she has paid zero through August. I do not know how they can be so much cheaper but she has found no downside to this plan.

David Shapiro
3 months ago
Reply to  jerry pinkard

My wife and I have used WellCare for 3 years, no issues at all, but we use only 3 common drugs, cost to us $0 or $15 for 3-month supply. Premium is only $0.40 per month this year, but going up to $16.80/month for 2025.

Last edited 3 months ago by David Shapiro
Jo Bo
3 months ago

Although I don’t quite understand it either, the zero-dollar Wellcare premiums appear to have a $15/mo government subsidy, for 2025, based on the Part D Premium Stabilization Demonstration provision of the Inflation Reduction Act. This is an opt-in provision for Part D providers, with two additional years left for the demonstration project.

Jane Lorentzen
4 months ago

I have used WellCare Value Script for my first year of coverage on Part D medicare. My premium is $0.50/month (that is not a typo). I have had no problems with using this insurance, and I’ve been pleasantly pleased with how smoothly it has flowed. I’ve called twice with questions and received competent input from customer service reps. I use expensive asthma inhalers and had to appeal for one to be covered; my doctor wrote the appeal and it was immediately covered. Also, I receive an expensive asthma biological injection monthly. Going to an infusion center to get this injection moved the billing from Part D coverage to Medicare Part B coverage, making it much cheaper. I plan to enroll in Well Care Value Script again this year.

baldscreen
4 months ago

We have used WellCare this year and no issues, but we just have generics. When I needed an antibiotic earlier in the year, it was only $3. We have not had to use their customer service. I have not checked our drugs for next year yet. Chris

David Lancaster
4 months ago

I threw out my Annual Notice of Change online from Aetna Silverscript as I always use the Medicare site annually to check coverage prices. However you failed to note that in addition to a 400% increase in the premium the deductible for tier 2-5 doubled from about $290 to $580 if I remember correctly.

Seems like they really don’t want to participate to me.

I had a significant disagreement with WellCare coverage for my brother years ago when he was in a nursing home so I have avoided them ever since.

Thanks to your post Andrew I will consider them again once I run our Rxs through the Medicare site.

Last edited 4 months ago by David Lancaster
Dan Smith
4 months ago

We have been using Wellcare for 3 years (I’m guessing). Have had no issues with service. In 2023 my premium was about $20 and Chris’s about $85 per month. For 2024 the premiums both dropped to $0. We don’t speak with our agent until 12/2 for the 2025 rates.

Rick Connor
4 months ago
Reply to  Dan Smith

We have a similar experience. Had WellCare since September 2022. Rates dropped to $0 in 2024. No issues to date. Caveat is we don’t have an expensive prescriptions. I only met the deductible this year when I was on Eliquis for a few months.

stelea99
4 months ago

In the 13 years I have had Medicare, I have had 8 different insurance companies. Their service in terms of dealing with pharmacies and paying for my drugs on the whole hasn’t differed much. Once or twice a company might have been slow in producing reports each month, but this is usually not that important. The only type of company I would be a little wary of using is one that is just getting into Part D plans.

This topic made me go to My Medicare to see what damage I might have suffered with the new $2k limit…..And, lo and behold looks like for my five drugs, my cost might go down by $1k…..perhaps a bit of this good fortune is because my one expensive drug is one of the 10 that is getting a lower negotiated price….I will be changing again. My current plan would go up 20% so that is a non-starter….

mytimetotravel
4 months ago

I used a WellCare plan from 2018 through 2021. This year I am on an Aetna plan. I have noticed no difference in customer service. However, as Dick says, the formulary is far more important. Right now my rheumatoid arthritis is in remission, but the drug I was taking for it is only covered by two drug plans next year, both with high premiums. It turns out that the $2,000 out-of-pocket max only applies to covered drugs and therefore my annual costs on the other plans would be nearly $70,000 which is a lot more than before the $2,000 limit, when I was paying around $6,000 a year for it. WellCare used to list it as a Tier 5 drug, but no longer. In fact, it covers very few RA drugs.

Costs vary not just by state but by county. If I don’t worry about the RA drug, WellCare will be the cheapest for me too next year, although I will be using GoodRX for my eye drops, which are not covered either.

Of course, another problem is that the formulary can change at any time….

mytimetotravel
4 months ago

The RA drug (Xeljanz) is at least $6,000/month retail. Previously, I hit catastrophic coverage by February, after which I paid 5% of retail. It had worked very well for me, but was starting to have unfortunate side effects. The substitute drug, which didn’t seem to be working, is on the WellCare formulary (Tier 5, prior approval), as is Enbrel, which I haven’t tried. Severe shortage of other RA drugs – even Humira isn’t listed. If my RA returns I’m planning to try infusions, which come under Medicare Part B.

GoodRX has Xeljanz at $3,000 month, which is a significant improvement from a couple of years ago. The cheapest on SingleCare is $5,000, but only one pharmacy is offering that price. Mark Cuban still doesn’t cover it.

R Quinn
4 months ago

It’s not really about the insurance company as much as the plan structure and the formulary and the history of premium changes with can be a reflection of actuarial accuracy in premium setting.

Our Blue Cross plan premium is going from $64.80 to $18.20 in 2025. However, the annual deductible increased from $545 to $590 and one tier drug group went from a co-pay to coinsurance.

The only way to make an assessment is based on total OOP costs for the drugs you are currently using as you have done.

If you are put on a new drug, check the formulary before filling the script. If there is a high cost check with doctor for alternative if any.

‘’I would not use GoodRx or similar until after you meet annual deductible. You want credit toward the deductible and OOP spending in case you later experience large drug expenses.

Bottom line is we pay now guaranteed via premiums or we maybe pay later via co-pays later based on drug use.

Liz Brennon
3 months ago
Reply to  R Quinn

You can, or at least you could, take what you paid for Rx’ed drugs not using your D and turn in the receipts to have it count for your out of pocket with your D. I haven’t checked if that rule is still in effect this coming year.

David Lancaster
4 months ago
Reply to  R Quinn

Using Good Rx, or in my case Mark Cuban’s Cost Plus, is still sometimes better. I had a Rx written for a steroid inhaler that for Aetna was a tier five medication. They did not cover cheaper alternatives thanks to the pharmacy benefits manager’s kickback (oops, sorry I mean rebate) to Aetna for covering only the more expensive tier 5 medication. Since I know that essentially a steroid inhaler is a steroid inhaler, I checked Cost Plus and an alternative was half the cost. Since I have one of these inhalers on standby in the rare (less than annually) instance when albuterol is not effective it saved me about $200. My other medications are all tier one so I never pay a deductible.

Last edited 4 months ago by David Lancaster
Liz Brennon
3 months ago

I don’t know if it is in effect for the upcoming year but you can take what you paid not using your D for Rx’ed drugs, turn in the receipts and have that count towards your deductible. That information is pretty well hidden.

R Quinn
4 months ago

Not using GoodRx toward deductible is a hedge against higher Rx expenses later in the year so that you get to the very low or no OOP cost sooner, but if that is not the case or not likely than it doesn’t matter much.

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