Frequently Asked Questions
Do you have questions? We have answers. Give us a call at 1.877.841.6072 (TTY 711) to have any of your Medicare or Prescription Drug Plan questions answered now or browse our FAQs below. WellCare representatives are here to help 8:00am – 8:00pm, 7 days a week.
- Who is eligible for Medicare benefits?
- What is the difference between Original Medicare and Medicare Advantage?
- I keep hearing about “parts” of Medicare insurance programs, what are they, and what do they mean?
- Certain preventive services are covered by Medicare. Why is this important?
- Are dental health services covered by Medicare?
- Are vision services covered by Medicare?
- How do I get prescription drug coverage?
- With so many options, choosing a Medicare Advantage plan can be confusing. How do I compare plans?
- When can I enroll or switch to a WellCare Medicare Advantage Plan?
- Can I find information on WellCare and other Medicare Advantage Plans through CMS?
- If I don’t like my WellCare plan, can I go back to Original Medicare?
If you qualify for Medicare & Medicaid...
- Do I have to pay a premium for Medicare Part A?
- What if I can’t afford my Medicare and drug coverage costs?
- I qualify for both Medicare and Medicaid. When can I make changes to my plan?
If you are turning 65...
- I am turning 65 soon. Am I automatically enrolled in Medicare?
- Do I have choices for my Medicare coverage?
- I’m covered by my employer’s health plan. Do I need Medicare?
- When can I make changes to my plan?
If you are moving...
- I’m moving. How does that affect my Medicare plan?
- How long do I have to make changes to my plan?
- Do the same rules apply for those in a skilled nursing facility or long-term care hospital?
Who is eligible for Medicare benefits?
You are eligible for Medicare benefits if you are:
- age 65 and entitled to monthly Social Security benefits.
- age 65 or over and have a spouse entitled to Social Security benefits, even if you are not.
- age 65 or over and are the widow/widower of someone entitled to Social Security benefits.
- under age 65 and have received Social Security disability benefits for at least 24 months.
- entitled to Social Security benefits and need maintenance kidney dialysis or a kidney transplant, regardless of your age.
What is the difference between Original Medicare and Medicare Advantage?
Medicare is a federal health insurance program. Generally, you are eligible for Medicare if you are 65-years of age or older, or if you are under the age of 65 with certain disabilities. The federal agency that administers Medicare is the Centers for Medicare & Medicaid Services (CMS). Medicare Advantage Plans are a type of Medicare health plan offered by a private company, such as WellCare, that contracts with CMS to provide you with all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. Consumers who qualify for Original Medicare can choose to enroll in Medicare Advantage plans; it is not a requirement to receive coverage through Original Medicare.
I keep hearing about “parts” of Medicare insurance programs, what are they, and what do they mean?
- Part A – Hospital Coverage
Helps cover hospital stays, including skilled nursing facilities, rehabilitation facilities and hospice care.
- Part B – Medical Coverage
Helps cover doctor and outpatient services, as well as some outpatient prescription drugs and may cover preventive services.
- Part C – Medicare Advantage Plans
Provided by private companies approved by Medicare, the plans cover the same services as Part A and Part B. Medicare Advantage plans can also include prescription drug coverage (Part D) and many offer extra coverage, such as vision and hearing care, dental services, and wellness programs.
- Part D — Prescription Drug Coverage
Optional coverage offered by private companies like WellCare to ensure all Medicare eligible beneficiaries have access to coverage to help with the cost of a broad range of prescription drugs.
There are four components of Medicare insurance:
Certain preventive services are covered by Medicare. Why is this important?
Medicare pays for many health care services to prevent illness (such as a flu shot) or to help detect an illness in the early stages so it can be managed before getting worse (such as cancer screening). Ask your doctor what tests you need and how often you need them.
Are dental health services covered by Medicare?
Original Medicare does not cover routine dental care or common dental procedures such as cleanings, fillings, extractions or dentures. Some Medicare Advantage plans, including WellCare, do include dental care as an added benefit. Call us to see if dental care is available in your area.
Are vision services covered by Medicare?
Original Medicare covers services for the diagnosis and treatment of eye disease both in your doctor’s office and the hospital, such as treatment of glaucoma and cataracts. Routine eye care, routine eyeglasses and contact lenses are not covered. Some Medicare Advantage plans, including WellCare, do include vision care as an added benefit. Call us to see if vision care is available in your area.
How do I get prescription drug coverage?
To get Medicare drug coverage, you must join a plan approved by Medicare, like WellCare. Some Medicare Advantage plans include prescription drug coverage. However, if it is not included, you have the option of joining a prescription drug plan (PDP). Benefits may vary by plan, so call us for details on the plans available in your area.
With so many options, choosing a Medicare Advantage plan can be confusing. How do I compare plans?
Focus on the benefits that are most important to you – such as the network of doctors, prescription drug coverage, etc. You can easily eliminate the plans that don’t offer those benefits. Then consider not only current health care costs, but future costs. Specific things you should compare: premiums, deductibles, co-payments and coinsurance. And call WellCare with any questions about any plan, we’ll help you sort through the options.
When can I enroll or switch to a WellCare Medicare Advantage Plan?
During the Initial Enrollment Period, you can enroll for a period of seven months – the three months before the month you turn 65 through the three months after the month you turn 65. You can also enroll and make changes during the Annual Enrollment Period, which takes October 15 to December 7 every year. There are also Special Election Periods throughout the year for specific situations that may allow you to make plan changes outside of the Annual Enrollment Period. Contact us for more information.
Can I find information on WellCare and other Medicare Advantage Plans through CMS?
Absolutely. You can contact CMS by calling 1-800-MEDICARE, or 1-800-633-4227 (TTY 1-877-486-2048) 24 hours a day, 7 days a week. Or visit their website at www.medicare.gov to get up-to-date information about Medicare. The site also has information about hospitals, nursing homes, physicians, home health agencies, and dialysis facilities – including booklets you can print directly from your computer. You will also find Medicare contacts for your state.
If I don’t like my WellCare plan, can I go back to Original Medicare?
It’s possible. You don’t lose your Medicare benefits when you join our plan. However, there are limits on when and how often you can change your Medicare Advantage plan. Contact us to find out more.
FAQs for those who are eligible for both Medicare and Medicaid…
Do I have to pay a premium for Medicare Part A?
You will not have to pay a monthly premium for Medicare Part A if you, or your spouse, paid Medicare payroll taxes while working. However, if you and your spouse did not work, or did not pay enough Medicare payroll taxes while working, then you may not be eligible for free Part A premiums.
What if I can’t afford my Medicare and drug coverage costs?
If you have limited income and resources, you have several options to help with medical and drug costs, like your premiums, deductibles, and other out-of-pocket expenses. Available programs include Extra Help, Low-Income Subsidies, State Pharmaceutical Assistance Programs and Pharmaceutical Assistance Programs. Call WellCare to determine if you are eligible for these programs.
I qualify for both Medicare and Medicaid. When can I make changes to my plan?
Anytime. You do not have to wait for the Annual Enrollment Period. You can join, switch, or drop your Medicare Advantage Plan or Medicare prescription drug coverage anytime throughout the year.
Certain restrictions apply if you are enrolled in a State Pharmaceutical Assistance Program (SPAP) or lose your SPAP eligibility. Additional rules apply if you have a severe or disabling condition, and there is a Medicare Chronic Care Special Needs Plan (SNP) available to you.
FAQs for those turning 65 and new to Medicare…
I am turning 65 soon. Am I automatically enrolled in Medicare?
You will be automatically enrolled in Medicare Part A and Part B effective the month of your 65th birthday. If you or your spouse paid Medicare payroll taxes while working and are entitled to monthly Social Security benefits, there is no monthly premium for your Part A coverage. Find out more about aging into Medicare!
Do I have choices for my Medicare coverage?
Yes you do. There are two main choices for getting your Medicare – Original Medicare or a Medicare Advantage Plan. If you choose Original Medicare (Part A and Part B), you will also have the option to enroll in a Prescription Drug Plan (Part D). Or you can choose a Medicare Advantage Plan, which gives you everything you get with Original Medicare and more. WellCare also offers Medicare Advantage plans that include drug coverage, so you would not need separate Part D coverage. Call us to find out which specific plans are available in your area.
I’m covered by my employer’s health plan. Do I need Medicare?
Yes. If you are actively working and have insurance coverage, you may be able to delay enrollment in Parts B and D without a penalty. However, if you don’t qualify for a later enrollment, you’ll end up paying higher premiums for the rest of your life. It is important that you check with your employer regarding your current plan’s rules. Your group insurance may require that you get Part B. Comparing costs and benefits will help you decide whether to select a prescription drug plan now, or later. Talk with your employer. Or, call us and we’ll give you the information you need to make your decisions.
When can I make changes to my plan?
Your initial enrollment period starts the three months before the month you turn 65 and end three months after. You then have a chance each year to make changes to your plans for the following year. That is called the Annual Enrollment Period, it takes place from October 15 through December 7. At that time you can change or switch your Medicare Advantage plans. You can also join, change, switch or drop your Medicare prescription drug plan. Special circumstances will allow changes at other times of the year. Please visit www.medicare.gov for details.
FAQs for those moving this year…
I’m moving. How does that affect my Medicare plan?
Your exact plan may not be available at your new address. Plans vary county by county and state by state. You should first contact your plan. Find out if your coverage will still be available, or if there are different options available to you.
How long do I have to make changes to my plan?
If you tell your plan before you move, you can switch plans beginning the month before your move and for the two full months after you move. If you tell your plan after you move, you can make changes during the month you tell your plan, plus the two full months following.
Do the same rules apply for those in a skilled nursing facility or long-term care hospital?
The rules are a little different. If you are moving into a care facility, you can join, switch, or drop coverage anytime of the year for as long as you live in the facility. If you are moving out of a care facility, you have the two full months after the month you move out of the facility to make your changes.
If you have a question that isn’t listed here, or if you need any information regarding your WellCare health plan coverage, please call us at 1.877.841.6072 (TTY 711) or contact us.
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