WellCare Classic (PDP) South Dakota Medicare Part D Plan S5967-162

WellCare Classic South Dakota Medicare Part D Plan S5967-162-SDWellCare Classic for South Dakota is a prescription drug plan (Medicare Part D Plan) that's available to seniors in South Dakota on Medicare. The Centers for Medicare & Medicaid Services (CMS) evaluated this plan's previous year performance and rated it 3.5 out of 5 stars ("Average") for quality.

If you enroll in this plan you'll pay the $33.70 monthly premium, and there's a $320.00 annual deductible before cost sharing begins. For more information about the costs, refer to 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 South Dakota, WellCare Classic is a cost sharing based prescription drug plan (PDP). The WellCare Classic PDP has three distinct costs: monthly premiums, an annual deductible, and co-payments.

The monthly premium is $33.70 ($404.40 paid annually), and the annual deductible is $320.00. 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.

Be aware that you must continue to pay your monthly premium even when you are not using any medications. Also, it's important to plan ahead because you are responsible for one hundred percent of your prescription costs until the plan's deductible has been met. You also make the required copayment when you pickup your prescriptions. These are your share of the prescription drug costs. The plan pays the rest until you reach the coverage gap (aka, “donut hole”).

There are two situations that can change how much an South Dakota Medicare Part D plan costs you. If your income is low and you are accepted into the Extra Help program administered by Social Security, your premium could be lower. It's also possible that your premium could be higher due to a late entry penalty. Be sure to speak with an authorized South Dakota Medicare Insurance Agent to get an exact quote for your situation.

Coverage Details

WellCare Classic for South Dakota 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. All Medicare prescription drug plans have co-pay requirements. The co-pay is the amount you pay when you fill your prescriptions. The co-payment schedule for this plan is on the co-pay page.

This PDP has a $320.00 deductible that you must pay at the pharmacy before the ICL phase of cost-sharing begins. The highest deductible allowed in 2015 is $320.

WellCare Classic Initial Coverage Limit

It's important to understand the initial coverage limit (ICL) and how it applies to you in South Dakota. The ICL is where you share the cost of your prescriptions with the insurance company. You and the carrier (WellCare) each pay your share until you reach a total of $2,960 spent at the pharmacy on prescriptions. At that point you pay all costs yourself because you're in the coverage gap, as explained below.

Medicare Part D Coverage Gap (Donut Hole)

The coverage gap, or donut hole, as it is often called, is the coverage phase where you no longer receive assistance from the plan. In other words, you pay for your prescriptions out-of-pocket. How quickly you reach the coverage gap with WellCare Classic all depends on your prescriptions. Most seniors never fall into the donut hole.

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 South Dakota. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local South Dakota 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$10.00869 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

Compare this plan with these South Dakota PDPs:


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 Sioux Falls, Rapid City, Aberdeen, Brookings, Watertown and all other towns and cities in South Dakota.

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 S5967-162 Summary of Benefits for South Dakota, visit the WellCare website, or call WellCare at N/A.