WellCare is a nationwide Medicare and Medicaid health insurer with over 4.5 million Medicare beneficiaries—most of whom have a standalone Part D plan with WellCare.1 This insurer also recently bought all Aetna’s Part D business. In short, WellCare covers a lot of Medicare beneficiaries across all 50 states and in Washington, DC.
Until this year, WellCare received average Medicare Star Ratings of 2.9.2 To put that into perspective, most Part D enrollees have plans rated at 3.5 or higher.3 In 2019, however, WellCare’s ratings got a boost to 3.75—just above the national average.4
If you can find one of their higher rated plans in your area, WellCare could be a good option for Part D coverage.
Who might want a WellCare Part D plan?
- People who shop at CVS: This preferred pharmacy has 9,800 locations nationwide5, so those who already shop here will find it convenient.
- People who find high-rated plans: While WellCare’s average Part D ratings are only slightly above average, you might find one of their higher quality plans near you.
- People who take mostly Tier 1 drugs: Many plans come with a $0 copayment for Tier 1 prescriptions filled by a preferred pharmacy.
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WellCare Part D prescription drug plans
WellCare operates under several regional brand names, such as Easy Choice in California and TexanPlus in Texas. If you look up WellCare Part D plans in your area, you may find yourself redirected to one of these brand’s websites.
WellCare sample Part D plans
|Tier 1 (preferred generics)|
|Tier 2 (generic drugs)|
|Tier 3 (preferred brand drugs)|
|Tier 4 (non-preferred brand drugs)|
|Tier 5 (specialty drugs)|
|Sample plan #|
Sample plans based on Wellcare.com and are for illustration purposes only. Actual plans may vary. All drug prices assume the prescription is filled at a preferred retail pharmacy for a 30-day supply. Data effective 5/13/19.
Plan options in each area vary widely, but in the plans we sampled, copayments for drugs in Tiers 1 through 3 are consistently just a few dollars (or $0) for a 30-day supply. To get the $0 copayment, you’ll need to fill them through CVS or Caremark—WellCare’s preferred pharmacies.
The WellCare Medicare Part D plan that works best for you may be determined by which medications you take.
Check your medications against WellCare’s drug formulary to find out which tiers they fall into.
WellCare Value Script (PDP)
This is WellCare’s basic plan. To receive coverage, you’ll first need to cover the $415 deductible out of pocket. Once you do, your costs will be lower.
A 30-day supply of Tier 1 drugs will cost you $0 if you use a preferred provider and anywhere from $5 to $15 if you don’t. This seems standard for WellCare plans. When it comes to Tiers 2 through 4, however, this plan is one of WellCare’s most expensive. The plan then levels back out at Tier 5, with some of WellCare’s most affordable cost sharing.
To summarize, people who take mostly Tier 1 or Tier 5 drugs will likely see the best savings with this plan.
WellCare Classic (PDP)
This plan’s monthly premium is a middle-of-the-road prescription drug coverage option, but it could lower your out-of-pocket costs the most. With this plan, your share of costs is WellCare’s lowest in every Tier except Tier 1. In that tier, you’ll have a $0 copayment, as did the other plans we sampled.
The downside? You’ll have to meet the $415 deductible first. But if you expect your annual costs to exceed that, your copayment and coinsurance savings could outweigh that initial cost.
This plan might be the right fit for Medicare recipients who take mostly Tiers 4 and 5 drugs. These drugs typically cost more than lower Tier medications, so your savings could add up quickly.
WellCare Extra (PDP)
Among the plans we sampled, this one generally had WellCare’s most expensive premium—but it comes with a $0 deductible, so your coverage will kick in right away.
Costs for medications in Tiers 1 through 4 are all comparable to the WellCare Value Script. Unfortunately, Tier 5 drugs cost significantly more due to a 33% coinsurance, compared to 25% in WellCare’s other plans. Because these drugs are often quite expensive to begin with, an 8% difference could quickly become significant.
If you take mostly Tier 1 or 5 drugs, this probably isn’t the best plan for you. If you take mostly Tier 2 through 4 drugs, don’t want a deductible, and expect your annual prescription costs to outweigh the higher premium, this plan could be a wise choice.
Bottom line: WellCare offers a variety of plans nationwide
If you can find one of WellCare’s higher rated plans in your area, this Part D insurer could be worth considering.
This company offers solid benefits, partnerships with CVS and Caremark, and availability nationwide. It’s quality ratings sit just above the national average, but individual plans may vary.
Whether you think WellCare is right for you or not, call the number below. A licensed sales agent can help you narrow your options and choose a plan that fits your needs.
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Want to learn more?
Will WellCare eliminate my Aetna plan?
To prevent a pharmaceutical monopoly during the 2018 CVS acquisition of Aetna, the US Justice Department required Aetna to sell all Part D business—which it did, to WellCare. WellCare made no changes to Aetna plans in 2019 but may do so in 2020. We’ll tell you more as that information becomes available.
How does the Donut Hole affect my WellCare Part D coverage?
Due to policies enacted as part of the Affordable Care Act, the Part D coverage gap (also known as the Donut Hole) will close completely in 2020. Once it does, your Medicare Part D costs will be 25% for both brand name and generic drugs, regardless of which company’s health plan you choose.
1 Centers for Medicare and Medicaid Services, “Enrollment by Contract”
2 Centers for Medicare and Medicaid Services, “2018 Star Ratings and Display Measures”
3 Centers for Medicare and Medicaid Services, “Medicare Provides Continued Access to High-Quality Health Coverage Choices in 2019”
4 Centers for Medicare and Medicaid Services, “2019 Part C and D Medicare Star Ratings Data”
5 Investopedia, “How CVS Makes Its Money”
Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively “Medicare System Providers”). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.