Wellcare for Part D?

[marko]

So, DW and I are going to change our drug plan because Humana increased the premium from $34 to $54.

Poking around we ran into Wellcare which offers premiums from $0 and $0.50. We're interested because we only use one or two Rx's: Simvastatin and one other generic. That is, we don't have major Rx demands.

How do they make any money with a $0 or 50 cent premium? I know it is but how is this legit? How do they charge nothing while others are charging $50+? I'm obviously missing something.

 

[aja8888]

So, DW and I are going to change our drug plan because Humana increased the premium from $34 to $54.

Poking around we ran into Wellcare which offers premiums from $0 and $0.50. We're interested because we only use one or two Rx's: Simvastatin and one other generic. That is, we don't have major Rx demands.

How do they make any money with a $0 or 50 cent premium? I know it is but how is this legit? How do they charge nothing while others are charging $50+? I'm obviously missing something.

I believe they (Like others), make money off the drugs and not much off premium. Plus, they make off the deductible (out of pocket for you) and if you hit the donut hole.

 

[marko]

I believe they (Like others), make money off the drugs and not much off premium. Plus, they make off the deductible (out of pocket for you) and if you hit the donut hole.

But they want to charge me $0 for my Simvastin...

Your saying that the higher drug users are where they make money?

 

[aja8888]

But they want to charge me $0 for my Simvastin...

Your saying that the higher drug users are where they make money?

When my DW was alive (she passed last December at 78 years old), we were spending $5 K a year on her expensive meds after deductible and discounts.

Yes, that's what I am saying. My one med costs me $15 for 90 days and it's generic. Some are $0 cost, like you say. When I had a flu like issue, the antibiotics the doc prescribed were $4.

 

[foxfirev5]

But they want to charge me $0 for my Simvastin...

Your saying that the higher drug users are where they make money?

DW and I have the cheap Wellcare plan and I see the premium went from $11/ month to $0 for 2024. I enroll each year through Via Benefits to get my former employers RHRA $. Via Benefits runs our prescriptions through a cost analysis and the Wellcare program has come out cheapest for the last two years. I only have one prescription for Atorvastatin which has zero cost for the year. DW on the other hand has a few that cause her to hit the doughnut hole each year around June. Still cheaper overall than any other plans offered. I have no idea how they make their money and only care about the total bottom line cost /year

I believe you can use the Medicare.gov website to run a cost analysis for your zip code.

 

[RetMD21]

The government pays 3/4 of the cost of the program so I imagine that they get a paid for having you on their rolls.

 

[Donno]

According to this guy, they are using the low price to get people to sign up, so they can get their personal information and call and upsell plans and sell Medicare Advantage plans. I'd take that argument with a grain of salt, but I suppose that is one way to buy a call list.

 

[zaqxsw]

According to this guy, they are using the low price to get people to sign up, so they can get their personal information and call and upsell plans and sell Medicare Advantage plans. I'd take that argument with a grain of salt, but I suppose that is one way to buy a call list.

I've had them for two years and plan to continue to roll over to them next year. No complaints except the usual with uneducated customer support. I always get it resolved.

I've never received a solicitation call or email for any of their other products. They are moving from WellCare mail order to Express Scripts in 2024. We'll see how that goes.

The only issue I've had with changing Part D plans is getting my existing Rx's moved over without the doctor issuing new scripts...

 

[CRLLS]

I've had them for two years and plan to continue to roll over to them next year. No complaints except the usual with uneducated customer support. I always get it resolved.

I've never received a solicitation call or email for any of their other products. They are moving from WellCare mail order to Express Scripts in 2024. We'll see how that goes.

The only issue I've had with changing Part D plans is getting my existing Rx's moved over without the doctor issuing new scripts...

Me too. I'll let it ride for another year.

Here is one example of their prices, today I picked up a prescription for upcoming cataract surgery. 3 eye drops were prescribed. 2 of them were $5 each, the third was around $35. I asked to check GoodRX prices on that 3rd one. GoodRx was about $10 less. So I had them put that prescription thru GoodRx. Another is DW gets a generic thru their mailorder plan. 90 day supply is $0.00 delivered. I don't think they are making it up on gouging prices when you can simply go thru another insurance/discount plan.

of course, check you own prescription prices and compare. Medicar.gov (I think) can give you the lowest price based on your prescription needs.

 

[Katsmeow]

One thing to look at is how they handle tier 3 and tier 4 drugs. On my current plan Tier 3 drugs have a co payment of $40 and Tier 4 have 45% coinsurance. The Wellcare plan we are talking about has a 25% coinsurance for Tier 3 drugs and 50% for Tier 4. Let's say I get prescribed a drug that is $1000 a month that is Tier 3 (there are plenty of these drugs). With my current plan I would pay $40. With Wellcare I would be $250 each month.

There is effectively a cap on out of pocket this year because you no longer have to contribute when you hit catastrophic. I read that this effectively makes your out of pocket max for this year as around $3300. (It will be less in 2025). With the Wellcare plan you are more likely to meet that $3300. Right now I take atorvastatin which has no cost. But, you never know what will happen

Via Benefits runs our prescriptions through a cost analysis and the Wellcare program has come out cheapest for the last two years. I only have one prescription for Atorvastatin which has zero cost for the year.

I have Via Benefits also. They pay my part B premium and my Part D up to about $29 a month before I run out of benefits. So I don't "need" to do the Wellcare. Usually there are a bunch of plans under $30 a month. This year I only hae 3 (Wellcare, Cigna and Mutual of Omaha). All of them have percentage charges for tier 3.

Atorvastatin doesn't cost anything. The thing I worry about is if there is some reason I have to quit taking it. My main alternative then would be a PSK9 Inhibitor which is costly. It is Tier 3 for Wellcare but the 25% coinsurance would be expensive.

My current plan's premium went up for $28 (and change) to $54.20. I would have to pay about $300 out of pocket for that increased premium. But I would save at least $2300 over the year if I needed one of those drugs. So it might make sense to just stay with the UH plan with the fixed co-pay for Tier 3 drugs.

 

[CincyDave]

I have Wellcare value scripts plan and also go through Via Benefits. Currently paying $11.20 a month and my 3 scripts are free. After seeing this thread, I looked at my plan through the Via website and it is showing a premium of $0 and drug cost of $0, so I guess that means next year my premium drops to $0.

 

[Ian S]

I was on Wellcare for Part D coverage for a couple of years before switching to the cheaper Silverscript plan. Now, that plan is doubling its premium so the Wellcare plan, even though one of my prescriptions will cost $2 a month, will be nearly $100 cheaper for the year with its $0 premium. I have to make sure that I'm not forced to use mail for long term prescriptions because our mailbox can get extremely hot in the summer which is not good for drugs.

 

[conversationalphrase]

I will add that my personal experience with Wellcare customer service was terrible. Multiple transfers and long hold times to get to someone who could help, but then couldn't so then another transfer. Literally on the phone for hours. All of the customer service representatives had heavy accents which made them difficult to understand. I'll pay a few more dollars for better service.


Currently I have Aetna Silverscript Smartsaver.