Looking back, looking forward . . .

This newsletter is very long but I encourage you to read it now and take action if needed. Wellcare is overwhelmed by the response to its’ low premium drug plan and this is creating problems for their policyholders (you and me).

Wellcare Switcheroo

In late December I received this email from a client regarding their Wellcare PDP plan.

Hi Bob,

My wife got a call from a Wellcare salesman in October trying to sell her on Medicare Advantage. She said NO, but somehow Wellcare decided it was better for her Part D (drug coverage) to be changed to their Medicare Advantage plan. So they changed it WITHOUT her knowledge or approval.

Questions:

1. How do we get it back to the way it was? OR

2. Even better, how does she change her plan to another company since she doesn't trust Wellcare? They said open enrollment is from Jan 1 - March 31. (This is a special Open Enrollment for folks on Medicare Advantage plans only. It does not apply to those with stand alone Part D coverage).

3. Has this affected her regular Medicare? and/or Part B? She wants to continue with traditional medicare and the Supplement she's already on.

She called Wellcare and spoke with the plan that was canceled as well as the new plan. They say she has to re-enroll even though it was their error.

Needless to say, she is very upset and stressed by this and wants it resolved as soon as possible.

Thanks for your help.

My client received a letter (dated 12/8/2023 AFTER the close of Open enrollment) from Wellcare stating she would be enrolled in their HMO Advantage plan as of 1/1/2024 and she was assigned to a network PCP.

My advice is to contact the MBO (Medicare Beneficiary Ombudsman) via 1-800-MEDICARE.

The MBO helps you with Medicare-related complaints, grievances, and information requests. The MBO makes sure you have information related to your Medicare rights and protections and how you can get your concerns resolved.

https://www.cms.gov/Center/Special-Topic/Ombudsman/Medicare-Beneficiary-Ombudsman-Home

I am penning this newsletter on January 2, 2024. At this point my client’s problem is not resolved and we have no idea how long the process will take or if the change will be retroactively effective to 1/1/2024 or not.

My suggestion is for the lady to reschedule any non-critical tests or procedures for January (when possible). Until this is resolved any medical and drug claims for January will be filed with the Wellcare HMO, not Medicare.

She will also need to pay her January Medigap premium, even though claims filed with the HMO will not be covered by original Medicare or her supplement plan. Failure to pay the January premium will result in a lapse of coverage. If that happens she may not be able to reinstate her Medigap plan, or possibly be blocked by other carriers where she could apply.

If the MBO is unable to fix the problem retroactively to January 1, the alternative is to enroll her in a different drug plan with a February effective date. Doing this will terminate her HMO as of 1/31 and restore original Medicare effective 2/1/2024.

This will make her “whole” again with original Medicare, Medigap and PDP but that leaves any January claims on the HMO.

Keep in mind this situation was initiated and created by Wellcare. My client did not want to change to an Advantage plan but was tricked by an agent that represents Wellcare.

Update 1/9/2024

After much back and forth my client has decided to stay with a Wellcare PDP, not out of loyalty, but the “numbers” make more sense in her situation.

The plan is to enroll her before the end of January in the Wellcare PDP . . . which will DISENROLL her from the Wellcare HMO which she NEVER wanted nor asked for.

Medicare A & B will revert to her primary payer, and her Medigap (which was never canceled) will resume as the secondary payer.

Just when you thought it was safe . . . this comes along. I got a call from a client asking how to pay his Wellcare premiums. My response is pasted below.

Applications were submitted and requested to have the premiums deducted from your SSA check  . . . which can still happen but you will have to call Wellcare to confirm this option.

Call Member Services @ 1-888-550-5252 and give them your name as it appears on your Wellcare card plus your member number

You can also go online to  member.wellcare.com, set up your account and payment information to use a credit card or bank draft.

You also should have received a payment book with stubs (like a car loan) and pay by mail using a check. They offer you the option to pay $6 for the year or $0.50 each month.

Rachel and I got our ID card and payment book about 10 days after enrolling in the drug plan. Your applications were submitted electronically on 11/26 so you should have received your enrollment "kit" several weeks ago.

DO THIS NOW

Find your Welcome to Wellcare kit and payment book.

Create a Wellcare account, or login to your account and go to PREMIUM PAYMENTS. See if your JANUARY premium has been paid. If it has NOT been paid yet DO IT NOW. If your drug plan is canceled due to non-payment of premium you cannot enroll in a NEW plan until the end of 2024 during open enrollment.

NEW coverage will begin 1/1/2025 and you will be charged a late penalty plus your new drug plan premium.

Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($32.74 in 2023) ($34.70 in 2024) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

If you have difficulty navigating the member.wellcare.com site call Member Services @ 1-888-550-5252

Protect Yourself from Fraud

Regardless of which drug plan you have, I am suggesting you take a few minutes to login to your MyMedicare account.

Do it now . . .

Go to the home page

https://www.medicare.gov/my/home

Scroll down to Your Plans and look for Drug Insurance (Part D). If you don’t see your CURRENT drug plan in that box, see if the Your Plans page indicates you are still covered by Original Medicare and Other Insurance shows your supplement plan.

If you have been switched to an Advantage plan that should be listed in the Other Insurance block.

If you WERE switched and want to go back to Medicare and a supplement plan let me know and I will try to change you back before it is too late and you are stuck in a PPO or HMO plan.

500 Drug Prices Change in January

Every year PBM’s change drug prices, tier levels and formularies AFTER December 7th. The result is, drug copays illustrated during Open Enrollment may not match what you pay when you fill your drugs.

Making matters worse, drug manufacturers will RAISE prices on over 500 drugs to be reflected in January, 2024.

Drugmakers including Pfizer (PFE.N), Sanofi (SASY.PA) and Takeda Pharmaceutical (4502.T) plan to raise prices in the United States on more than 500 drugs in early January, according to data analyzed by healthcare research firm 3 Axis Advisors.

The expected price hikes come as the pharmaceutical industry gears up for the Biden Administration to publish significantly discounted prices for 10 high-cost drugs in September, and continues to contend with higher inflation and manufacturing costs.

Under President Joe Biden's Inflation Reduction Act (IRA), the government's Medicare health program can negotiate prices directly for some drugs starting in 2026.

https://www.reuters.com/business/healthcare-pharmaceuticals/drugmakers-set-raise-us-prices-least-500-drugs-january-2023-12-29

And finally . . .

The problems in the world are much greater than we are. Regardless of your faith, keep this in mind as we move through the year. Prayer works!

Please forward this newsletter to your friends, and pass my name along to folks turning 65 or looking to make a change in their Medigap plan.

Bob