WellCare Classic for South Dakota is a prescription drug plan (PDP) that's available to seniors in South Dakota on Medicare. The Centers for Medicare & Medicaid Services (CMS) evaluated this Medicare Part D plan's previous year performance and rated it 2.5 out of 5 stars (Below Average) for quality.
If you choose to enroll you will pay $32.20 per month (the premium). In addition to the premium there is a $360.00 annual deductible. You can find out more about the costs associated with this plan in the premium section of this page. You can check out the coverage information in the coverage secrion, or look at the copayments section to see your costs at the pharmacy.
WellCare Classic is a cost sharing prescription drug plan (PDP). There are three distinct costs: monthly premiums, an annual deductible, and co-payments or co-insurance.
The annual premium on this PDP is $386.40 ($32.20 per month), and breaks down as follows:
This plan is not available to people receiving low income subsidy (LIS) benefits.
There is a $360.00 annual deductible with this PDP. For 2016, the maximum Part D deductible is $360. 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.
You Pay the Premium + Deductible + Copayments
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)
What You Pay Could Be Different
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 South Dakota Medicare Insurance Agent to get an exact quote for your situation.
WellCare Classic is a Basic Alternative PDP. At a minimum, WellCare must offer a "standard benefit" package mandated by law. The standard benefit includes an annual deductible and a gap in coverage, aka, donut hole. Carriers may also offer plans that:
- are actuarially equivalent to the standard benefit; or
- are enhanced, offering benefits in addition to the standard benefit.
Typically, enhanced plans offer additional coverage during the coverage gap. If you fell into the donut hole last year, shop enhanced plans.
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 WellCare each pay your share until you reach a total of $3310.00 spent at the pharmacy on prescriptions. At that point you pay all costs yourself because you're in the coverage gap, as explained below.
Coverage Gap (aka, Donut Hole)
When you fall into the coverage gap, or donut hole as many people call it, you are basically uninsured and must pay for all of your prescription costs out-of-pocket. When you reach the coverage gap will all depend on your prescriptions. Most seniors never exceed the ICL and don't have to worry about it. If you are on a long-term medication that's costly, you could reach the donut hole very quickly.
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
WellCare Classic does not offer additional assistance in the coverage gap. 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 (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
|Tier||You Pay||Medications in Tier|
|3||$47.00||Preferred Brand Drugs|
|4||50%||Non-Preferred Brand Drugs|
IMPORTANT: In order to determine if this is the best PDP for you, it's critical that you lookup your prescriptions in the plan's formulary.
WellCare Classic has an overall rating of 2.5 out of 5 stars. This summary rating was assigned by the Centers for Medicare and Medicaid Services (CMS) based on the plan's previous year performance. It provides shoppers with an overall score on the drug plan's quality and performance across 3 broad categories:
- Drug plan customer service (4.0 stars): Includes handling of member appeals.
- Member experience with the plan's drug services (3.0 stars): Includes ratings of member satisfaction with the plan.
- Drug safety and accuracy of drug pricing (3.0 stars): Includes how accurate the plan's pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is considered safer and clinically recommended for their condition.
CMS gathers quality information from several sources, including member surveys, reviews of billing and other information that plans submit to Medicare, and other monitoring activities.
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 PDP information is maintained by David Bynon and was last updated on .