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Información básica sobre los planes de cobertura de medicamentos recetados

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Medicare Part D prescription drug plans are also known as PDPs. Medicare Part D is a government program that offers prescription drug insurance to everyone who is entitled to Medicare Part A and/or enrolled in Medicare Part B.

When you are ready to decide on a plan, take the time to understand how the plans work. That way, you can make an informed decision and choose the plan that's right for you.

Los diferentes planes PDP cubren distintos medicamentos

El Gobierno federal tiene pautas específicas para los tipos de medicamentos que debemos cubrir, así como un estándar mínimo de beneficios que debemos seguir.

Cada plan tiene un formulario (una lista de medicamentos cubiertos) que cumple estos requisitos de acuerdo con la ley. Hay que recordar que no todos los planes son iguales. Los costos pueden variar, así como los medicamentos específicos cubiertos.

Si se inscribe en un plan de Medicare Parte D, revise el formulario del plan para asegurarse de que satisface sus necesidades de cobertura de medicamentos recetados.

Si actualmente tiene un plan Medicare Advantage

Si su plan Medicare Advantage incluye cobertura de medicamentos recetados y se une a un plan PDP de Medicare, perderá su inscripción en el plan Medicare Advantage y volverá a tener el plan Medicare Original con su PDP de Medicare.

Multa por inscripción tardía a la cobertura de medicamentos de Medicare (Parte D)

La multa por inscripción tardía es un monto que se agrega a su prima mensual del plan de medicamentos de Medicare (Part D). Es posible que deba una multa por inscripción tardía si, en cualquier momento después de que su Período de Inscripción Inicial haya finalizado, hay un período continuo de 63 días o más en el que no tiene cobertura de medicamentos de Medicare u otra cobertura acreditable de medicamentos recetados. Por lo general, deberá pagar la multa durante el tiempo que tenga cobertura de medicamentos de Medicare.

Cuando se trata de la cobertura, usted tiene opciones:

  • Puede obtener la cobertura de medicamentos recetados de Medicare mediante un PDP de Medicare (Parte D).
  • Puede inscribirse en un plan Medicare Advantage (HMO o PPO) u otro plan de salud de Medicare que ofrezca la cobertura de medicamentos recetados de Medicare.

Más ahorros. Mayor cobertura. Atención personalizada.

  • Wellcare ofrece planes diseñados para ayudar a las personas que cumplen con los requisitos para recibir Extra Help (Subsidio por Ingresos Bajos), en los que los miembros pueden no pagar primas, o pagar primas y copagos bajos si están inscritos
  • Los planes con primas bajas también están disponibles en todos los estados, con copagos que comienzan desde los $0 cuando se compra en farmacias preferidas
  • Wellcare también ofrece planes sin deducibles, lo que significa que el plan comienza a cubrir los costos de los medicamentos recetados desde el primer día
  • Thousands of network pharmacies are available nationwide in our network including national, regional and local chains, grocers and independent pharmacies
  • Nos asociamos con farmacias preferidas para ayudar a los miembros a ahorrar dinero. Las farmacias preferidas de nuestra red incluyen muchas tiendas minoristas nacionales y regionales conocidas. Utilice nuestra herramienta
    Buscar un Proveedor para encontrar su farmacia preferida más cercana

Member Service representatives are ready to help you with any questions about your coverage or medications. For a complete list of drugs covered by our plan, please review our website or contact our member services department.

Información importante

Renuncia de Responsabilidades Legales

‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc.

Wellcare es la marca de Medicare para Centene Corporation, un plan HMO, PPO, PFFS, PDP con un contrato de Medicare y es un patrocinador aprobado de la Parte D. Nuestros planes D-SNP tienen un contrato con el programa estatal de Medicaid. La inscripción a nuestros planes depende de la renovación del contrato.

Washington residents: “Wellcare” is issued by Wellcare of Washington, Inc.

Washington residents: “Wellcare” is issued by WellCare Health Insurance Company of Washington, Inc.

Washington residents: “Wellcare” is issued by Coordinated Care of Washington, Inc.

Washington residents: “Wellcare” is issued by Coordinated Care of Washington, Inc., a subsidiary of Centene Corporation.

“Wellcare” is issued by WellCare Prescription Insurance, Inc.

Medicare evalúa los planes en función de un sistema de clasificación de 5 estrellas todos los años.

Los proveedores fuera de la red o no contratados no tienen la obligación de tratar a los miembros del Plan, excepto en situaciones de emergencia. Llame a nuestro número de servicio al cliente o consulte su Evidencia de Cobertura para obtener más información, incluido el costo compartido que se aplican a los servicios fuera de la red.

Wellcare’s pharmacy network includes limited lower-cost, preferred pharmacies in rural areas of Georgia, Hawaii, Missouri, and Nebraska. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-866-892-8340 (TTY: 711) for Wellcare No Premium (HMO) in GA or consult the online pharmacy directory at www.wellcare.com/medicare; 1-877-457-7621 (TTY: 711) for Wellcare ‘Ohana No Premium (HMO) and Wellcare ‘Ohana Low Premium Open (PPO) in HI or consult the online pharmacy directory at www.wellcare.com/ohana; 1-833-444-9088 (TTY: 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), and Wellcare Assist (HMO) in MO or consult the online pharmacy directory at www.wellcare.com/medicare; and 1-800-977-7522 (TTY: 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), Wellcare No Premium Open (PPO), and Wellcare Assist Open (PPO) in NE or consult the online pharmacy directory at www.wellcarene.com.

Los Artículos y Servicios de Valor Agregado (VAIS) no constituyen beneficios del plan y no están cubiertos por el plan. Los miembros del plan son responsables de todos los costos.

Louisiana D-SNP members: As a Wellcare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through Wellcare and are also eligible to receive additional health care services and coverage through Louisiana Medicaid. Learn more about providers who participate in Louisiana Medicaid by visiting www.myplan.healthy.la.gov/en/find-provider or www.louisianahealthconnect.com. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid and select the “Learn about Medicaid Services” link. To request a written copy of our Medicaid Provider Directory, please contact us.

Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid or www.louisianahealthconnect.com. To request a written copy of our Medicaid Provider Directory, please contact us.

Notificación: TennCare no es responsable del pago de estos beneficios, excepto por los montos de costos compartidos correspondientes. TennCare no es responsable de garantizar la disponibilidad o calidad de estos beneficios. Cualquier beneficio que no esté incluido en los beneficios tradicionales de Medicare se aplica solamente a Wellcare Medicare Advantage y no es un indicador de un aumento de los beneficios de Medicaid.

Texas D-SNP members: As a Wellcare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through Wellcare and are also eligible to receive additional health care services and coverage through Texas Medicaid. Learn more about providers who participate in Texas Medicaid by visiting wellcarefindaprovider.com. For detailed information about Texas Medicaid benefits, please visit the Texas Medicaid website at www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. To request a written copy of our Medicaid Provider Directory, please contact us.

Texas D-SNP prospective enrollees: For detailed information about Texas Medicaid benefits, please visit the Texas Medicaid website at www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. To request a written copy of our Medicaid Provider Directory, please contact us.

Wellcare (HMO and HMO SNP) includes products that are underwritten by WellCare of Texas, Inc., WellCare National Health Insurance Company, and SelectCare of Texas, Inc.

Wellcare Dual Liberty (HMO-D-SNP) Plan

Wellcare Dual Liberty (HMO D-SNP) is a Fully Integrated Dual Eligible Special Needs Plan with a Medicare contract and a contract with the New Jersey Medicaid program. Enrollment in Wellcare Dual Liberty depends on contract renewal.  This information is not a complete description of benefits. Contact the plan for more information. Limitations and restrictions may apply. Benefits may change on January 1 of each year.  Your Part B premium is covered by Medicaid.  This plan is available to those who have both Medicare and full Medicaid benefits.  Wellcare uses a formulary.  There is no obligation to enroll.  Please contact Wellcare for details.

When joining this plan:

1.) You must use in-network providers, DME (durable medical equipment) suppliers, and pharmacies.

2.) You will be enrolled automatically into Medicaid (NJ FamilyCare) coverage under our plan and disenrolled from any Medicaid (NJ FamilyCare) plan you are currently enrolled in. All of your Medicaid-covered services, items, and medications will then be covered under our plan, and you must get them from in-network providers.

3.) You will be enrolled automatically into Part D coverage under our plan, and you will be automatically disenrolled from any other Medicare Part D or creditable coverage plan in which you are currently enrolled.

4.) You must understand and follow our plan’s rules on referrals.

  • Renuncia de responsabilidades legales

    Renuncia de Responsabilidades Legales

    ‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc.

    Wellcare es la marca de Medicare para Centene Corporation, un plan HMO, PPO, PFFS, PDP con un contrato de Medicare y es un patrocinador aprobado de la Parte D. Nuestros planes D-SNP tienen un contrato con el programa estatal de Medicaid. La inscripción a nuestros planes depende de la renovación del contrato.

    Washington residents: “Wellcare” is issued by Wellcare of Washington, Inc.

    Washington residents: “Wellcare” is issued by WellCare Health Insurance Company of Washington, Inc.

    Washington residents: “Wellcare” is issued by Coordinated Care of Washington, Inc.

    Washington residents: “Wellcare” is issued by Coordinated Care of Washington, Inc., a subsidiary of Centene Corporation.

    “Wellcare” is issued by WellCare Prescription Insurance, Inc.

    Medicare evalúa los planes en función de un sistema de clasificación de 5 estrellas todos los años.

    Los proveedores fuera de la red o no contratados no tienen la obligación de tratar a los miembros del Plan, excepto en situaciones de emergencia. Llame a nuestro número de servicio al cliente o consulte su Evidencia de Cobertura para obtener más información, incluido el costo compartido que se aplican a los servicios fuera de la red.

    Wellcare’s pharmacy network includes limited lower-cost, preferred pharmacies in rural areas of Georgia, Hawaii, Missouri, and Nebraska. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-866-892-8340 (TTY: 711) for Wellcare No Premium (HMO) in GA or consult the online pharmacy directory at www.wellcare.com/medicare; 1-877-457-7621 (TTY: 711) for Wellcare ‘Ohana No Premium (HMO) and Wellcare ‘Ohana Low Premium Open (PPO) in HI or consult the online pharmacy directory at www.wellcare.com/ohana; 1-833-444-9088 (TTY: 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), and Wellcare Assist (HMO) in MO or consult the online pharmacy directory at www.wellcare.com/medicare; and 1-800-977-7522 (TTY: 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), Wellcare No Premium Open (PPO), and Wellcare Assist Open (PPO) in NE or consult the online pharmacy directory at www.wellcarene.com.

    Los Artículos y Servicios de Valor Agregado (VAIS) no constituyen beneficios del plan y no están cubiertos por el plan. Los miembros del plan son responsables de todos los costos.

    Louisiana D-SNP members: As a Wellcare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through Wellcare and are also eligible to receive additional health care services and coverage through Louisiana Medicaid. Learn more about providers who participate in Louisiana Medicaid by visiting www.myplan.healthy.la.gov/en/find-provider or www.louisianahealthconnect.com. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid and select the “Learn about Medicaid Services” link. To request a written copy of our Medicaid Provider Directory, please contact us.

    Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid or www.louisianahealthconnect.com. To request a written copy of our Medicaid Provider Directory, please contact us.

    Notificación: TennCare no es responsable del pago de estos beneficios, excepto por los montos de costos compartidos correspondientes. TennCare no es responsable de garantizar la disponibilidad o calidad de estos beneficios. Cualquier beneficio que no esté incluido en los beneficios tradicionales de Medicare se aplica solamente a Wellcare Medicare Advantage y no es un indicador de un aumento de los beneficios de Medicaid.

    Texas D-SNP members: As a Wellcare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through Wellcare and are also eligible to receive additional health care services and coverage through Texas Medicaid. Learn more about providers who participate in Texas Medicaid by visiting wellcarefindaprovider.com. For detailed information about Texas Medicaid benefits, please visit the Texas Medicaid website at www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. To request a written copy of our Medicaid Provider Directory, please contact us.

    Texas D-SNP prospective enrollees: For detailed information about Texas Medicaid benefits, please visit the Texas Medicaid website at www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. To request a written copy of our Medicaid Provider Directory, please contact us.

    Wellcare (HMO and HMO SNP) includes products that are underwritten by WellCare of Texas, Inc., WellCare National Health Insurance Company, and SelectCare of Texas, Inc.

    Wellcare Dual Liberty (HMO-D-SNP) Plan

    Wellcare Dual Liberty (HMO D-SNP) is a Fully Integrated Dual Eligible Special Needs Plan with a Medicare contract and a contract with the New Jersey Medicaid program. Enrollment in Wellcare Dual Liberty depends on contract renewal.  This information is not a complete description of benefits. Contact the plan for more information. Limitations and restrictions may apply. Benefits may change on January 1 of each year.  Your Part B premium is covered by Medicaid.  This plan is available to those who have both Medicare and full Medicaid benefits.  Wellcare uses a formulary.  There is no obligation to enroll.  Please contact Wellcare for details.

    When joining this plan:

    1.) You must use in-network providers, DME (durable medical equipment) suppliers, and pharmacies.

    2.) You will be enrolled automatically into Medicaid (NJ FamilyCare) coverage under our plan and disenrolled from any Medicaid (NJ FamilyCare) plan you are currently enrolled in. All of your Medicaid-covered services, items, and medications will then be covered under our plan, and you must get them from in-network providers.

    3.) You will be enrolled automatically into Part D coverage under our plan, and you will be automatically disenrolled from any other Medicare Part D or creditable coverage plan in which you are currently enrolled.

    4.) You must understand and follow our plan’s rules on referrals.

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Y0020_WCM_134133E_M Last Updated On: 5/8/2024
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