WellCare Classic (PDP) Colorado Medicare Part D Plan S5967-164

WellCare Classic Colorado Medicare Part D Plan S5967-164-COWellCare Classic for Colorado is a Medicare Part D prescription drug plan. It's approved by the Centers for Medicare and Medcaid Services (CMS) for people in Colorado with Medicare benefits. CMS gave it a quality rating of 3.5 out of 5.0 stars ("Average").

If you enroll in this plan you'll pay the $40.90 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 Colorado, WellCare Classic is a cost sharing based prescription drug plan (PDP). If you enroll in the WellCare Classic PDP, you share in the overall costs with the insurer by paying a monthly premium, an annual deductible (if applicable), and copayments at your pharmacy.

This plan's annual premium is $490.80 ($40.90 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)

There are two situations that can change how much an Colorado 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 Colorado Medicare Insurance Agent to get an exact quote for your situation.

Coverage Details

WellCare Classic for Colorado 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 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

The ICL is the same for all Colorado 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 Colorado.

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.

When you're in the donut hole you pay all of the costs for your medications, but at a discounted rate (47.5% off of brand-name drugs and 28% off generics). You continue to pay this until your out-of-pocket costs reach $4,550. At this point Medicare takes over by giving you catastrophic coverage. The $4,550 out-of-pocket figure does not include your monthly premiums or what WellCare pays.

Additional Gap Coverage with WellCare Classic

Some plans offer additional gap coverage. WellCare does not offer additional coverage with the WellCare Classic PDP in Colorado. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local Colorado 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$7.00869 Non-Preferred Generics
3$39.00774 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 Colorado 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 Denver, Aurora, Colorado Springs and all other towns and cities in Colorado.

This catalog is maintained by David Bynon and was last updated on 9/13/2015. CMS File Date: October 15, 2014.

About WellCare

For more information, download the Summary of Benefits WellCare Classic (PDP) Medicare Part D Plan S5967-164 Summary of Benefits for Colorado, visit the WellCare website, or call WellCare at N/A.