WellCare Signature PDP for Maine Seniors
|Initial Coverage Limit:||$2,930.00|
|Pharmacy Mail Order:||Yes|
|Gap Coverage:||Few Generics|
|Low Income Subsidy:||No|
|PDP ID No:||S5967-035|
|Approved by CMS for:||ME Residents|
|Rx Plan Type:||Regional|
|Members in Region:||6151|
2013 Medicare Prescription Drug Plan Overview
ME WellCare Signature (PDP) is a Medicare prescription drug plan underwritten by WellCare for eligible residents of Maine. The plan is approved by CMS for drug formulary 00012166, which has 2506 FDA approved medications. The monthly premium is $45.60 ($547.20 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).
Maine 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 Signature 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 Maine with this plan is as follows:
|Tier||Co-Pay Amount||Medications in Tier|
|1||$0.00||1292 Preferred Generics|
|2||$20.00||378 Non-Preferred Generics|
|3||$45.00||304 Preferred Brand Drugs|
|4||$90.00||329 Non-Preferred Brand Drugs|
|5||33%||203 Specialty Drugs|
The 2012 Initial Coverage Limit with WellCare Signature is $2,930.00. 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: Less than 10% of formulary generics are covered, but you must pay for Brand Drugs up to $3727.50. Use our free Maine donut hole calculator to estimate out-of-pocket expenses for your precscription drugs with this policy.
The number of Medicare recipients using the WellCare Signature plan nationally is 216,809. In your area (CMS PDP region 1) there are a reported 6,151 seniors on this plan. That's based on the previous year's reporting information.
More Information 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.
The summary (overall) rating for this WellCare plan is 3.5 out of 5 based on reviews from 6151 user ratings from the previous year. For more information about the review process, visit http://cms.gov.