Q: Can I make a plan change from One WellCare PFFS Health Plan to another WellCare Medicare Advantage Plan?
A: Yes, members will have an opportunity to choose a new WellCare Medicare Advantage plan during a special election period that runs through January 31, 2010. If you join a new plan AFTER December 31st your new coverage will not start until the month after you join.
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GETTING CARE Q: My WellCare PFFS plan was cancelled. Do I have insurance coverage?
A: You are covered by Original Medicare unless you enrolled with another Medicare Advantage company. Show your Original Medicare card or new insurance card when obtaining medical services. 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: I just went to the pharmacy and they said that I no longer have WellCare PFFS coverage.
A: Correct, WellCare PFFS discontinued all of our plans effective 1/1/2010. Each member was notified in October of the changes with a non-renewal letter that included informative details about 2010 options. Q: With PFFS insurance discontinue, do I have prescription drug insurance coverage at this time?
A: If you were enrolled in the PFFS Concert plan in 2009 and have not enrolled in another Medicare Advantage Plan with drug coverage or a stand alone Prescription Drug Plan (PDP) you do not have drug coverage. You need to seek prescription drug coverage immediately. You DO have medical insurance coverage through Original Medicare. 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.
Q: I currently have a stand-alone drug plan (PDP) (Part D) coverage with WellCare, do I loose my drug coverage too?
A: No, your stand-alone Part D drug coverage with WellCare will remain in effect. You will continue to have WellCare Part D coverage in 2010 unless you choose another plan during open enrollment or if you qualify for a special enrollment period.
Q: I have a WellCare PFFS plan with drug coverage. Am I losing that as well? (Or I am a Concert member with drug coverage, what are my options?)
A: You can join another Medicare Advantage plan that offers prescription drug coverage or another Medicare Advantage plan without prescription drug benefits and join a separate stand-alone Medicare prescription drug plan. If you choose Original Medicare, it does not include drug coverage, so you will have to join a stand-alone Medicare prescription drug plan if you want it. Please refer to the letter we sent you dated November 2, 2009 for complete details on options available.
Q: I have a low-income subsidy – what do I need to do?
A: If you qualify for Extra Help (the low-income subsidy) for 2010, you need to join a new Medicare Advantage plan with drug coverage or join a Medicare Prescription Drug Plan by December 31. If you do not choose a new plan by December 31, you may begin 2010 without drug coverage. If you do not choose a new drug plan yourself, Medicare will assign people who qualify for Extra Help to a new plan for 2010. However, that new coverage may not begin until March 2010 and you may not have coverage for January and February. Avoid a break in your coverage by joining a new plan by December 31.
Top PFFS DISCONTINUES PLANS FOR 2010
Q: I just received a letter from my insurance agent stating that WellCare PFFS will no longer be available in 2010, is this correct?
A: Yes, WellCare PFFS has decided not to offer Medicare Advantage Plans in 2010.
Q: I just read in the paper that WellCare PFFS will stop providing service in 2010, is this correct?
A: Yes, WellCare PFFS has decided not to offer Medicare Advantage Plans in 2010.
Q: Why is WellCare PFFS leaving my area?
A: Each year, we review our health plan offerings to determine if any adjustments should be made for the following year with respect to our plan designs and the counties/states in which they are offered. Based on our thorough review, we determine what plans we will be offering or bidding for in various counties/states. Our decisions are based on a number of factors, including the competitive environment.
Q: What will happen to my healthcare coverage?
A: Members will have an opportunity to choose a new Medicare Advantage plan or return to Original Medicare coverage during a special election period that starts on October 1, 2009, and runs through January 31, 2010. Members should make plans to switch to a new plan that will be effective January 1, 2010. Unless you act before December 31, you will only have Original Medicare coverage starting January 1, 2010. If you join a new plan AFTER December 31, your new coverage will not start until the month after you join.
Please refer to the letter we sent you, dated November 2, for complete details on options available and alternative Medicare Advantage Plans in your area. In general:
- You can join another Medicare Advantage plan or other Medicare health plan, including a plan that offers prescription drug coverage.
- You can change to Original Medicare. If you decide you want Original Medicare coverage, you may want to join a Medicare Prescription Drug Plan. You may also want to buy a Medigap policy.
- If you choose not to take any action, you will return to Original Medicare.
Q: When does my coverage with WellCare PFFS end?
A: December 31, 2009
Q: What are my options for insurance coverage?
A: Please refer to the letter we sent you, dated November 2, for complete details on options available and alternative Medicare Advantage Plans in your area.
In general:
- You can join another Medicare Advantage plan or other Medicare health plan, including a plan that offers prescription drug coverage.
- You can change to Original Medicare. If you decide you want Original Medicare coverage, you may want to join a Medicare Prescription Drug Plan. You may also want to buy a Medigap policy.
- If you choose not to take any action, you will return to Original Medicare.
Q: When will I receive information about my WellCare PFFS benefits for next year?
A: WellCare will not offer Private Fee-for-Service (PFFS) plans in 2010 and therefore you will not be receiving benefit information about WellCare PFFS. However, you should have received a letter with complete details on options available for 2010 and alternative Medicare Advantage Plans in your area. It is dated November 2.
Q: When will I receive my new ID card for 2010?
A: All WellCare Medicare Advantage PFFS plans— including plans referred to as Concert, Melody, Melody-Plus, Prelude, Quartet, Sonata, Sonata-Plus and Serenade plans—will be discontinued on January 1, 2010 and therefore you will not receive an ID card.
For services after January 1, 2010, you should continue to use your Original Medicare ID Card to obtain services unless you have enrolled in another Medicare Advantage Plan. If you have enrolled in another Medicare Advantage Plan, please contact their customer service department to find out about the status of your Member ID Card.
Q: I get help from Medicaid, what do I need to do?
A: The Non-Renewal Letter that WellCare sent to you has all of the Medicaid contact information you need.
Q: My provider is no longer accepting WellCare PFFS Plans prior to December 31, 2009, what do I do?
A: Please contact our customer service department and provide them with the provider information. We will outreach to the provider and discuss any concerns or issues they may have.
Top CLAIMS SUBMISSION
Q: How do I submit my claims?
A: Your doctor should submit any medical claims directly to us for any services rendered. Below is the address where providers can submit claims. It is also located on the back of your member ID card. Please remember to take your ID card with you to your doctor’s office.
Medicare-Covered Claims:
WellCare Health Plans, Inc.
P.O. Box 4438
Scranton, PA 18505
Non-Medicare-Covered Claims:
Dental
Doral National Medicare Plan
P.O. Box 45
Grafton, WI 53024
Vision
Advantica EyeCare
P.O. Box 6546
Ellicott City, MD 21042
Hearing
HearUSA Hearing Care Network
P.O. Box 220807
West Palm Beach, FL 33422
Q: I paid for a medical bill, how do I get reimbursed?
A: You can be reimbursed for covered services up to the Medicare/Plan allowable amount less any member cost sharing, by submitting a copy of the bill, proof of payment, and a letter explaining the details. Claims should be submitted to the address below, which is also located on your ID card.
WellCare
P.O. Box 4438
Scranton, PA 18505
Q: How long do I have to submit a claim?
A: You must submit a claim to WellCare PFFS for an Original Medicare-covered service within the same period you would have to submit under Original Medicare, which is within 15-27 months from the date of service. (For services received between October 1, 2007, and September 30, 2008, claims must be submitted by December 31, 2009. For services received between October 1, 2008, and September 30, 2009, claims must be submitted by December 31, 2010.) Failure to be timely with claim submissions may result in non-payment.
Top APPEALS AND GRIEVANCE
Q: Can I still file an appeal or grievance after January 1, 2010?
A: Yes, Grievances must be submitted to the Plan within 60 calendar days of the event-giving rise to the complaint.
Yes, Appeals must be submitted to the Plan within 60 calendar days of the denial for services or payment for services previously rendered.
Top MEDIGAP
Q: What is a Medigap policy?
A: A Medigap policy is a health insurance policy sold by private insurance companies. Costs you pay for Medicare benefits — like coinsurance, copayments and deductibles— are called “gaps” in Original Medicare. You might want to buy a Medigap policy to help cover these gaps. Some Medigap policies also cover benefits that are not covered by Medicare, like emergency health care while traveling outside the United States.
Medigap coverage is different from your Medicare Advantage coverage. Since Medigap polices only help pay for health care costs if you are in Original Medicare, you do not need a Medigap policy if you are in a Medicare Advantage plan.
Q: Does WellCare offer any Medigap policy?
A: At this time, WellCare does not offer Medigap policies.
Q: When can I apply for Medigap?
A: You can apply for a Medigap policy now. If you want to buy a Medigap policy, follow these steps: - Contact the insurance company that sells the Medigap policy you want, and ask for an application.
- Fill out the application, and make a copy of the cover letter that came with this mailing. It will prove that you have special rights to buy a Medigap policy.
- Mail the application and a copy of the letter to the Medigap insurance company.
Remember, you must apply for the policy by March 4, 2010 if you stay in our plan until December 31, 2009. This is 63 days after your coverage under WellCare PFFS ends. If you leave our plan before December 31, 2009, you have 63 days from the day your coverage ends to apply for a Medigap policy. It’s best to apply before your coverage with our plan ends so that your Medigap policy starts the same day as your Original Medicare coverage.
Q: For More Information about Medigap Policies
A: At this time, WellCare does not offer Medigap policies.
- Visit www.medicare.gov/Publications/Pubs/pdf/02110.pdf to view the booklet, “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.”
- Call your State Insurance Department to get more information. Call 1-800-MEDICARE (1-800-633-4227) to get the telephone number. TTY users should call 1-877-486-2048.
- Visit www.medicare.gov and select “Compare Medicare Health Plans and Medigap Policies in Your Area.”
- Call 1-800-MEDICARE (1-800-633-4227).
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