WellCare Classic (PDP) Missouri Medicare Part D Plan S5967-155

WellCare Classic Missouri Medicare Part D Plan S5967-155-MOWellCare Classic for Missouri is a Medicare Part D prescription drug plan. It's approved by the Centers for Medicare and Medcaid Services (CMS) for people in Missouri with Medicare benefits. CMS gave it a quality rating of 3.5 out of 5.0 stars ("Average").

If you choose to enroll you will pay $31.20 per month (the premium). In addition to the premium there is a $320.00 annual deductible. You can find out more about the costs associated with this plan on the premium page. You also have co-payments when you pickup your prescriptions at the pharmacy. Be sure to look at the coverage page to make sure it fits your needs.

This plan is not available to people receiving low income subsidy (LIS) benefits.

Premium Details

Like all Medicare Part D plans sold in Missouri, WellCare Classic is a cost sharing based prescription drug plan (PDP). With the WellCare Classic PDP you have several different costs, including the premium (monthly), a deductible (annual), and pharmacy co-pays.

This plan's annual premium is $374.40 ($31.20 paid monthly), and it has a $320.00 deductible. For 2015, the maximum Part D deductible is $320. A plan with the maximum deductible does not necessarily mean that it is more expensive than a plan with a lower deductible or no deductible at all. You need to consider all costs.

Here's a rundown of your shared costs. Like all other types of insurance, you must pay your premium. The premium has nothing to do with how many prescriptions you have filled. If the plan has a deductible, you must pay one hundred percent of your prescription costs until you reach the amount of the deductible. When the deductible is met, then you pay the copayment amount at the pharmacy. All other costs are paid by the plan until you hit the donut hole (initial coverage limit)

For all seniors on Medicare, there are two conditions that could affect how much you pay for this plan. If you qualify for the Social Security Extra Help program your premium will generally be lower. Also, if you enrolled late the Centers for Medicare and Medicaid Service may impose a premium penalty. Contact your local Missouri Medicare Insurance Agent to get an exact quote for your situation.

Coverage Details

WellCare Classic for Missouri seniors features an initial coverage limit (ICL) of $2,960, and there is a $320.00 deductible. Be aware that the ICL is calculated using the full retail price of your medications, not the amount paid by the insurance carrier. When you pick up your prescriptions you will need to make a co-payment. The co-payments page will show you your share at the pharmacy with this plan.

This prescription drug plan has a $320.00 deductible that must be paid before the ICP cost-sharing phase begins. The highest deductible Medicare allows is $320. This figure goes down a few dollars each year.

WellCare Classic Initial Coverage Limit

The ICL is the same for all Missouri plans, but it changes from year-to-year. If you enroll in WellCare Classic, you share the cost of all covered medications with WellCare, the insurance carrier. You each pay your share until $2,960 has been spent at the pharmacy. If you reach that level of spending on your prescriptions then you fall into the dreaded coverage gap and you are responsible for all costs. Fortunately, automatic discounts kick in to help you until you qualify for Medicare's catastrophic coverage in Missouri.

Medicare Part D Coverage Gap (Donut Hole)

When you reach the coverage gap, commonly called the donut hole, you pay for your medications yourself. Most seniors never go into the coverage gap, but it is possible to hit it quickly if you have expensive long-term prescriptions.

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.

Additional Gap Coverage with WellCare Classic

Some plans offer additional gap coverage. WellCare does not offer additional coverage with the WellCare Classic PDP in Missouri. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local Missouri Medicaid office. You may qualify for additional assistance. The Social Security Administration's Extra Help program is another opportunity for seniors on Medicare who are not able to afford their prescriptions.

Copayment & Coinsurance Details

In addition to the monthly premium and annual deductible, the WellCare Classic prescription drug plan has copayments and/or coinsurances that you must pay when you pickup your medications. Here's the schedule for this plan:

Tier  Co-Pay AmountMedications in Tier
1$0.00293 Preferred Generics
2$12.00869 Non-Preferred Generics
3$36.00774 Preferred Brand Drugs
4$89.00629 Non-Preferred Brand Drugs
525%382 Specialty Drugs

The WellCare Classic Medicare Part D plan uses WellCare formulary number 00015235, which covers 2947 generic and brand name drugs.

Compare Plans

Here are a few more PDPs available in Missouri that deserve a look:


If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the WellCare Classic prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Saint Louis, Kansas City, Springfield, Independence, Columbia, Lees Summit, O'Fallon, Saint Joseph, Saint Charles, Blue Springs, Saint Peters, Florissant, Joplin, Chesterfield and all other towns and cities in Missouri.

This catalog is maintained by David Bynon and was last updated on 9/14/2015. CMS File Date: October 15, 2014.

About WellCare

For more information, download the Summary of Benefits WellCare Classic (PDP) Medicare Part D Plan S5967-155 Summary of Benefits for Missouri, visit the WellCare website, or call WellCare at N/A.