Q: How can WellCare afford to do this?
A: WellCare has been in business for over 23 years. We have the experience to stretch your health care dollars by contracting with the federal government to administer your Medicare coverage.
Q: If I don't like my new plan, can I go back to Original Medicare?
A: Of course. You don't lose your Medicare benefits when you join a WellCare plan. We just take care of them for you. However, there are limits on when and how often you change your Medicare plan options. Call us to find out more.
Q: Can I make a plan change from One WellCare Health Plan to another?
A: WellCare is not currently accepting enrollment plan changes in our WellCare Health Plans at this time. Q: Can I enroll in a WellCare Medicare Plan?
A: WellCare is not currently accepting new enrollments in our WellCare Health Plans at this time. Top
ADVANTAGES Q: What's the difference between WellCare PFFS Plans and Medicare HMOs?
A: With WellCare PFFS plans, you are not restricted to a network of providers. You can choose the doctors and hospitals that agree to accept our terms and conditions of payment, and you don't need a referral to see a specialist. Top
WHAT'S COVERED Q: Will I have the same coverage as I do with Original Medicare?
A: PFFS plans are in place of Original Medicare and offer extra benefits such as dental, hearing, vision, and prescription drug coverage. If you have questions about whether your PFFS plan will pay for specific services, including inpatient hospital services, you have the legal right to receive a written and binding determination of coverage in advance. Call your WellCare customer service representative to ask if a service is covered, and request a written confirmation. Your PFFS plan may also require a pre-approval of a service. Check your Evidence of Coverage document (EOC) if you are not sure. Q: Can I receive emergency care?
A: You have the right to emergency care, when needed, anywhere in the U.S. and without pre-approval from WellCare. Q: Do PFFS plans cover services that Medicare does not consider medically necessary?
A: A PFFS plan is not required to pay for services that are not medically necessary under Medicare. However, WellCare PFFS Plans do pay for additional benefits not covered by Original Medicare. If you receive a service that is not covered by a plan, you are responsible for the cost of that service. If you are not sure whether a service is covered by WellCare, you have the right to call us and ask for an advance decision. Top
GETTING CARE Q: Does WellCare offer Private Fee-for-Service network plans?
A: WellCare offers two plans, WellCare Melody-Plus and WellCare Sonata-Plus that offer a network of Primary Care Physicians (PCPs). These PCPs have agreed to provide you with your health care coverage. These plans offer a lower in-network co-payment; you will pay a higher co-payment for out-of-network PCP visits. Q: What do I need to do to get care?
A: Our plans work just like traditional insurance. Just show your WellCare Member ID card (instead of your Medicare card) at the doctor's office. You may have a small co-pay due at that time. That's it. There are virtually no forms or paperwork to fill out because you don't have to file claims. Q: What happens if my doctor is not familiar with WellCare PFFS Plans?
A: If your doctor or health care provider would like more information about WellCare PFFS, ask them to call our Provider Service Center at 1-866-235-2770. The Provider Service Center is available Monday through Sunday, 7:00 a.m to 2:00 a.m. Eastern. Terms and conditions are available on our web site. Participation by providers is voluntary. You can go to any doctor, specialist or hospital that accepts Medicare payment, along with the terms, conditions, and payment rate for WellCare PFFS. Q: Can WellCare ever drop my coverage?
A: Once you're enrolled, you cannot be disqualified for any medical condition. However, if you move out of our service area, fail to pay your premium, or commit fraud, WellCare reserves the right to disenroll you. All Medicare Advantage plans commit to the program for a full year. Each year, WellCare decides whether to continue a plan for another year. Even if a Medicare Advantage Plan is discontinued, you will not lose Medicare coverage. If a plan is discontinued, WellCare must notify you in writing at least 90 days before your coverage ends. The letter will explain your options for Medicare coverage in your area. Top
COSTS Q: Do I still have to pay my Part B premium?
A: Yes. When you join a WellCare PFFS Plan, you must continue to pay your Part B premium. You must also continue to pay your Part A premium, if applicable. Some of WellCare's PFFS plans offer a partial rebate of your Part B premium. If joining the Prelude Plan, your rebate is set up and paid through Medicare and Social Security Administration (SSA). Depending on how you pay for your Medicare Part B premium statement. Rebates typically take several months to be issued; however, you will receive a full credit. If you're on Medicaid, your Part B premium is paid by the state, and an additional rebate cannot be obtained. Top
PART D TRANSITION POLICY Q: One of the prescriptions I usually take isn't on the WellCare formulary. What should I do?
A: Read our 2009 Transition Policy. Top PRESCRIPTION DRUG COVERAGE
Q: What if I have to pay cash for my prescription because I do not have my WellCare insurance card?
A: You will need to complete a Direct Member Reimbursement (DMR) Form.
Download a Direct Member Reimbursement form
When completing the form, you will need to provide your information or the member’s information if you are filling it out for someone else. This information includes the member’s information such as Name, Birthdate, ID Number, and current Address. Also, the form includes a section for the pharmacy that dispensed the prescription and the specific prescription information that you (or the member) paid cash for. The DMR form provides helpful information on where to locate the necessary information on the prescription label when you are completing the DMR form. Please be sure to include a detailed prescription receipt or pharmacy printout. The prescription receipt or pharmacy printout must include the member’s name, pharmacy name, physician name, drug name, drug strength, quantity, NDC number, days supply and the amount paid by the patient. Handwritten receipts will not be accepted. If you have questions about the prescription or pharmacy information, please contact the pharmacy that dispensed your medication. Or, you can call the Customer Service Phone number listed on the back of your WellCare membership card. It is extremely important to completely fill out the DMR form. Also, make sure that you keep a copy of the form and the receipts for your records.
Q: How will I know if WellCare is going to pay me for the prescriptions when I did not have my WellCare insurance card?
A: WellCare will send you a letter that informs you of our decision concerning the request for payment of your the prescriptions. You should expect to receive this letter within 7 - 10 business days.
Q: What if I mailed my request for WellCare to pay for my prescriptions four weeks ago, but I have not received any information?
A: Please contact the Customer Service Phone number listed on the back of your WellCare membership card. They will be able to provide you information including whether or not WellCare has received your request. Top | 
