Q: What is a Medicare Advantage HMO plan?
A: A Medicare Advantage HMO plan is offered by a private company that contracts with Medicare to provide you with all your Medicare Part A (hospital) and Part B (medical) benefits. It is a health maintenance organization, or HMO. That means it provides care through a network of providers. Care is coordinated through the primary care physician (PCP), who may refer people to specialists as needed. Referrals are generally required to see specialists.
Q: What is a Medicare Advantage HMO POS plan?
A: A Medicare Advantage HMO POS also provides care through a network of providers. However, it includes a point of service (POS) feature, which allows members to receive health care services outside of the network with authorization from the plan, although use of providers within the network is encouraged.
A: A networkis a group ofdoctors and other health care professionals, medical groups, hospitals and other health care facilities that have an agreement with us todeliver covered services to members in our plan. The providers in our network generally bill us directly for care they give you. When you see a network provider, you usually pay only your share of the cost for their services.
Q: Where can I get information about basic Medicare terms?
A: We want you to make an informed decision about your Medicare health plan. That’s why we created a glossarylocated in your state's Medicare Basics page.
Q: Should I still keep my red, white and blue Medicare card?
A: Yes. However, as long as you are a member of our plan you must useyour WellCare Member ID Medicare card to get covered medical services (with the exception of clinical research studies and hospice services). Keep WellCare Member ID Medicare card in a safe place in case you need it later. If your WellCare ID card is damaged, lost or stolen, contact usright away and we will send you a new card.
Q: If I do not like my Wellcare plan, can I go back to original Medicare?
A: Of course. You do not 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 usto find out more.
Q: I'm signed up to get my medications via mail service. How do I order refills?
A: There are three ways to refill:
1. Online. Ordering refills at CVS Caremark.com is convenient, fast and easy! Register online to receive refill reminders and other important updates. Have your WellCare ID card handy to register.
2. By Phone. Call the toll-free Customer Care number on your prescription label for fully automated refill service. Have your benefit ID number (BIN) ready. This number can be found on your WellCare ID card.
3. By Mail. You will receive an order form with every mail service order. Simply fill in the ovals for the refills you want to order. If you need a refill for a prescription not listed on the form, write the prescription number in the space provided. Send the form to CVS Caremark along with your payment.
Allow up to 10 days from the day you submit your order for delivery of your medicine. Regular delivery is at no cost to you. Overnight or second-day delivery is available for an additional charge.
Q: How do I get permission to receive services?
A: You can get service authorizations from you primary care provider (PCP) or from specialists you're referred to.
Q: Will I have the same coverage as I do with Original Medicare?
A: Our plans are required to cover all services and procedures that are covered by Original Medicare. However, our plans also offer extra benefits not covered by Original Medicare, which may include routine dental, routine hearing, routine vision and prescription drug coverage.Please note that, as a member of our plan, your use/participation in a limited number of services, such as clinical research studies and hospice services, will be paid for directly by Medicare. Becoming a member of our plan does not make you ineligible to receive these services.
Q: Can I receive emergency care?
A: You have the right to emergency care, when needed, anywhere in the United States and without pre-approval from us.
Q: Do HMO or HMO POS plans cover services that Medicare does not consider medically necessary?
A: An HMO or HMO POS plan is not required to pay for services that are not medically necessary under Medicare. However, WellCare plans do pay for additional benefits not covered by Original Medicare. If you receive a service that is not covered by our plan, you are responsible for the cost of that service. If you are not sure whether a service is covered, you have the right tocall usand ask for an advance decision.
Q: What do I need to do to get care?
A: Our plans work just like a traditional health insurance. Just show your WellCare Member ID card (instead of your Medicare card) at the doctor's office. You may have a co-payment due at that time.
Q: What happens if my doctor is not familiar with Wellcare Medicare Advantage Plans?
A: If your doctor or health care provider would like more information about WellCare, ask him or her to contact us. Our Customer Service representatives are ready to answer questions.
Q: Can WellCare ever drop my coverage?
A: Once you are enrolled, you cannot be disqualified for any medical condition. However, if you move out of our service area or commit fraud, Wellcare reserves the right to disenroll you.All Medicare Advantage plans commit to their members for a full year. Each year, WellCare decides whether to continue a plan for another year. Even if a Medicare Advantage Plan is discontinued at the end of a benefit year, you will not lose Medicare coverage. If your plan is discontinued, Wellcare must notify you in writing at least 60 days before your coverage ends. The letter will explain your other options for Medicare coverage in your area.
Q: What if I need to talk to a nurse?
A: One of the perks of being a Wellcare member is our 24-hour Nurse Advice Line at 1-800-581-9952. (TTY users dial 711)Our nurses will give you answers to your medical questions and help you decide whether or not to see your doctor or go to the emergency room. Nurses are available 24 hours a day, 7 days a week. You can also find the number on the back of your Member ID card.
Q: Do I still have to pay my Medicare Part B premium?
A: Yes. When you join a Wellcare plan, you must continue to pay your Medicare Part B premium unless it's paid for you by Medicaid or another third party. If you meet certain eligibility requirements for both Medicare and Medicaid, your Part B premium may be covered in full. Some of WellCare's Plans help by reducing your Medicare Part B premium.The reduction is set up by Medicare and administered through the Social Security Administration (SSA). Depending on how you pay your Medicare Part B premium, your reduction may be credited to your Social Security check or credited on your Medicare Part B premium statement. Reductions may take several months to be issued. However, you will receive a full credit.
