WellCare Classic Colorado Medicare Part D Plan S5967-164

WellCare Classic  Medicare prescription drug plan for Colorado SeniorsWellCare Classic for Colorado is Medicare Prescription Drug Plan (Part D Plan or PDP) for seniors and other Medicare beneficiaries in Colorado. According to the Centers for Medicare and Medicaid Services (CMS), this plan's quality is Below Average, and rated it 2.5 out of 5.0 stars.

The monthly premium is $40.40. It features a $360.00 deductible. There are more cost related details in the premium section on this page. You can see your share at the pharmacy in the co-pay section, or learn more about the coverage in the coverage section.

Cost Details

WellCare Classic does not pay all costs; it's a cost sharing plan. If you join, you share in the overall costs with WellCare by paying a monthly premium, an annual deductible (if applicable), and copayments and/or coinsurance at your pharmacy.

Premium

This plan's annual premium is $484.80 ($40.40 paid monthly). It's priced as follows:

Basic Premium:$40.40
Supplemental Premium:$0.00
Full Premium:$40.40

Low-Income Subsidy

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

Deductible

This plan has a $360.00 deductible (annual). 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

You are required to pay your premium each month, even if you don't fill a prescription. Plus, you'll pay all of your prescription costs until the annual deductible amount has been paid (if any). You'll also pay the required copayment at your pharmacy when you have your prescriptions filled. These are your costs and the plan pays the rest.

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 Colorado Medicare Insurance Agent to get an exact quote for your situation.

Coverage Details

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

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. You each pay your share until $3310.00 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.

Coverage Gap (aka, 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

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 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 (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 PayMedications in Tier
1$0.00Preferred Generics
2$8.00Non-Preferred Generics
3$47.00Preferred Brand Drugs
450%Non-Preferred Brand Drugs
525%Specialty 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.

Quality Rating

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.

Availability

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.

About WellCare

For more information, download the Summary of Benefits (N/A), visit the WellCare website, or call WellCare at 866-530-9491.

This PDP information is maintained by and was last updated on .