Wellcare Medicare Part D plans help cover prescription drug costs for Medicare beneficiaries. These plans are designed to be affordable and accessible across all 50 states.
This article explains how Wellcare Medicare Part D works, its benefits, and key details for 2025. Let’s explore what you need to know to make informed choices.
What Is Wellcare Medicare Part D?
Wellcare Medicare Part D is a prescription drug plan (PDP) offered by Wellcare, a Centene Corporation subsidiary. It provides coverage for outpatient prescription drugs for those with Original Medicare (Parts A and B).
These plans are available to anyone eligible for Medicare, regardless of health status.
The plans cover a wide range of medications, from generics to specialty drugs. Wellcare offers multiple plan options to fit different budgets and needs. Each plan follows Medicare’s guidelines and includes a formulary, or list of covered drugs.
Why Choose Wellcare Medicare Part D?
Wellcare Medicare Part D plans are known for affordability and flexibility. Many plans, like the Wellcare Value Script, offer low or $0 premiums in certain areas. They also include access to a nationwide network of pharmacies.
These plans help manage drug costs, especially for those with chronic conditions. With Wellcare, you get support from a dedicated Member Services team. This makes navigating your coverage easier.
How the Formulary Works
The formulary is a list of drugs covered by Wellcare Medicare Part D plans. It’s updated regularly to include new medications and generics. The formulary organizes drugs into tiers, which affect your out-of-pocket costs.
You can check the formulary on Wellcare’s website using the Drug Search Tool. If your medication isn’t listed, alternative drugs may be covered. Always review the formulary to avoid surprises at the pharmacy.
Drug Tiers and Costs
Wellcare Medicare Part D uses a tiered system to determine drug costs. Lower tiers have lower copays, while higher tiers cost more. Here’s a simple breakdown of the typical tiers:
- Tier 1: Preferred generics, often $0 copay at preferred pharmacies.
- Tier 2: Other generics, low copays like $10–$20.
- Tier 3: Preferred brand-name drugs, typically 25% coinsurance.
- Tier 4: Non-preferred brands, around 45% coinsurance.
- Tier 5: Specialty drugs, highest cost at 33% coinsurance.
Tiers help you understand what you’ll pay for each prescription. Costs vary by plan and pharmacy.
Table: Sample Wellcare Medicare Part D Costs (2025)
| Tier | Drug Type | Copay/Coinsurance (Preferred Pharmacy) |
|---|---|---|
| 1 | Preferred Generics | $0 |
| 2 | Generics | $10–$20 |
| 3 | Preferred Brands | 25% coinsurance |
| 4 | Non-Preferred Brands | 45% coinsurance |
| 5 | Specialty Drugs | 33% coinsurance |
Note: Costs depend on your plan, state, and pharmacy. Check your plan’s details for accuracy.
Coverage Phases in 2025
Wellcare Medicare Part D follows Medicare’s coverage phases. First is the deductible phase, where you pay full drug costs up to $590. Some plans, like Wellcare Medicare Rx Value Plus, may have a $0 deductible for certain tiers.
Next is the Initial Coverage phase, where you pay copays or coinsurance. Once you and your plan spend $2,000, you enter the Catastrophic Coverage phase. Here, out-of-pocket costs are capped at $2,000 for the year.
Special Features of Wellcare Plans
Wellcare Medicare Part D plans offer unique benefits. Many include $0 copays for Tier 1 and Tier 2 drugs at preferred pharmacies like CVS or Walgreens. Adult vaccines, like shingles or RSV, are covered at no cost.
The plans also support the Medicare Prescription Payment Plan. This lets you spread drug costs across monthly payments. This can make high-cost medications more manageable.
Using Network Pharmacies
Wellcare has a network of over 60,000 pharmacies nationwide. Using in-network or preferred pharmacies saves money. Out-of-network pharmacies may lead to higher costs unless it’s an emergency.
You can find a pharmacy using Wellcare’s Find a Provider Tool online. Popular options include CVS, Walgreens, and many grocery store pharmacies. Always confirm a pharmacy’s status before filling prescriptions.
Mail-Order Pharmacy Benefits
Wellcare partners with Express Scripts Pharmacy for mail-order services. You can order up to a 100-day supply of maintenance medications. This is convenient for drugs you take regularly.
Mail-order often costs less than retail pharmacies. Prescriptions are delivered to your door with free standard shipping. You can track orders online or by phone.
Coverage for Specific Needs
Wellcare Medicare Part D covers medications for chronic conditions like diabetes or hypertension. Preferred diabetes testing supplies, such as glucose meters, are also included. Check the formulary for specific brands.
Some plans cover select vitamins like folic acid or vitamin D2. Generic erectile dysfunction drugs may also be included. Always verify coverage for your specific needs.
Handling Non-Covered Drugs
If a drug isn’t on the Wellcare Medicare Part D formulary, you have options. Your doctor can suggest a covered alternative that works for you. Another option is requesting a coverage exception.
To request an exception, your doctor must submit a form to Wellcare. Fax it to 1-866-388-1767. Wellcare will review and decide if they’ll cover the drug.
Understanding Deductibles and Premiums
For 2025, Wellcare Medicare Part D plans like Value Script have a $590 deductible for higher tiers. Some plans offer $0 premiums, making them budget-friendly. Premiums and deductibles vary by state and plan.
Once you meet the deductible, you pay copays or coinsurance. The $2,000 out-of-pocket cap ensures costs don’t spiral. Check your plan’s Evidence of Coverage for exact details.
How to Access Plan Information
Visit www.wellcare.com to explore Wellcare Medicare Part D plans. The secure Member Portal lets you view your plan details, formulary, and ID card. You can also download a temporary ID card.
Call Member Services at 1-800-977-7522 for help. They’re available from 8 a.m. to 8 p.m., seven days a week. The team can answer questions about coverage or pharmacies.
Changes for 2025
Wellcare Medicare Part D plans have some updates for 2025. The deductible for the Value Script plan increased from $545 to $590. The out-of-pocket maximum is now $2,000, per Medicare rules.
Some drugs may shift tiers or be added/removed from the formulary. Wellcare notifies members of changes via the List of Drugs Change Notice. Check the website for updates.
Enrollment and Eligibility
Anyone enrolled in Medicare Part A or B can join a Wellcare Medicare Part D plan. Enrollment happens during the Annual Enrollment Period (AEP), from October 15 to December 7, 2024, for coverage starting January 1, 2025. Special Enrollment Periods may apply for certain life events.
To enroll, visit Wellcare’s website or call 1-844-657-2460. You can also use Medicare’s Plan Finder tool to compare plans. Make sure to review plan details before enrolling.
Tips to Save on Drug Costs
To lower costs, use preferred pharmacies for $0 or low copays. Check the formulary for generic alternatives. Mail-order services can also save money on long-term medications.
If costs are high, explore Extra Help, a Medicare program for low-income beneficiaries. Wellcare’s Member Services can guide you on assistance options. Planning ahead keeps expenses manageable.
Why Wellcare Stands Out
Wellcare Medicare Part D plans are affordable and widely available. With 102 PDPs nationwide, they cater to diverse needs. The $0 premium option and low copays make them attractive.
Wellcare’s focus on generics and preferred pharmacies reduces costs. Their Member Services team provides clear support. This makes Wellcare a strong choice for prescription coverage.
Summary
Wellcare Medicare Part D plans offer affordable prescription drug coverage for 2025. With options like the Value Script plan, you get low premiums and access to over 60,000 pharmacies.
The formulary lists covered drugs, organized by tiers, with a $590 deductible for some plans. Use preferred pharmacies, mail-order services, or the Medicare Prescription Payment Plan to save money. If a drug isn’t covered, request an exception or explore alternatives with your doctor.
FAQ
What is Wellcare Medicare Part D?
It’s a prescription drug plan for Medicare beneficiaries, covering outpatient medications. Wellcare offers plans like Value Script with low or $0 premiums. Check the formulary to confirm drug coverage.
How do I find out if my drugs are covered?
Use the Drug Search Tool on Wellcare’s website or download the formulary PDF. Search for your medication by name. Call Member Services at 1-800-977-7522 for help.
What if my medication isn’t on the formulary?
Ask your doctor about covered alternatives or request a coverage exception. Your doctor must submit a form to Wellcare. Fax it to 1-866-388-1767 for review.
What are the costs for Wellcare Medicare Part D in 2025?
Plans may have a $590 deductible for higher tiers and $0 copays for Tier 1 drugs. Out-of-pocket costs are capped at $2,000. Costs vary by plan and pharmacy.
Can I use mail-order services with Wellcare?
Yes, Express Scripts Pharmacy offers mail-order for up to a 100-day supply. It’s cost-effective and includes free shipping. Order through Wellcare’s website or Member Portal.