A: There are four easy ways to enroll. Choose the one that works best for you.
- Enroll online: View our plans and complete your application online.
- Enroll over the phone: Our representatives can enroll you over the phone. Call 1-888-293-5151, during the hours of 8 a.m. and 8 p.m. EST.
- Enroll at Medicare.gov: Medicare beneficiaries may also enroll in Wellcare through the CMS Medicare Online Enrollment Center located at Medicare.gov.
- Enroll by mail or fax: Download, print and complete our enrollment form. Return your completed and signed form to us by fax or mail using the contact information on the form.
A: Use our helpful Plan Comparison tool to compare your Wellcare plans options and choose the plan that’s right for you.
With our plan comparison tool, you can review plan details, compare prescription drug costs, and more!
Q: When can I enroll or make a plan change into a prescription drug plan?A: You can join switch or leave a prescription drug plan at these times:
Initial Coverage Election Period
The Medicare Initial Coverage Election Period is based on the month of your 65th birthday. You can enroll as early as three months before your birthday month or as late as three months after your birthday month.
Annual Enrollment Period (AEP)
The Medicare Annual Enrollment Period is from October 15 to December 7, during this time you can:
- Enroll in a Medicare Part D or Medicare Advantage plan from Original Medicare.
- Enroll from one Medicare Part D or Medicare Advantage plan to another.
- Enroll in original Medicare from a Medicare Advantage Plan.
Changes made to coverage during this time would take effect January 1 of the new plan year.
Special Enrollment Periods (SEP)
You could qualify for a Special Enrollment Period during any month when certain events happen in your life. Reasons you could qualify include:
- You have changed your permanent residence.
- You have recently moved to a new service area.
- You want to switch to a plan with a 5-star overall quality rating.
A: The Centers for Medicare & Medicaid Services (CMS) may have [automatically enrolled] you in a Wellcare Medicare Prescription Drug Plan if you qualify for Extra Help and did not choose a Medicare Part D drug plan on your own.
CMS does this to ensure:
- You have prescription drug coverage
- You get your medications without a gap in coverage
- Your premium is completely covered by the government subsidy
A: To search for your medications you can view our online Formulary:
- Wellcare Classic Plan
- Wellcare Value Script Plan
If you prefer a copy of the Formulary to be mailed to you, you can request one by calling Member Services at 1-888-550-5252 (TTY: 711) between Oct. 1 and March 31, Monday through Sunday, from 8 a.m. to 8 p.m. or April 1 and Sept. 30, Monday through Friday, from 8 a.m. to 8 p.m. or within the Member Portal by chatting live with an agent at member.wellcare.com.
Q: What is a Formulary?A: A Formulary is a list of prescription drugs covered by your plan. It can also show what you may pay for each drug and if there are any special rules, like needing approval before the plan covers it.
If you are working with a licensed sales representative, he or she will have a copy of the Formulary and can help you look up the medications you take. You can also find the Formulary online at Wellcare.com/PDP or request a copy by calling 1-888-550-5252 (TTY 711) between Oct. 1 and March 31, Monday through Sunday, from 8 a.m. to to 8 p.m. or April 1 and Sept. 30, Monday through Friday, from 8 a.m. to 8 p.m.
Q: Does a higher drug tier mean I will pay more?A: Not always. Drug tiers help explain how your plan covers a drug, but they do not always show your final cost. Your cost can change based on your pharmacy, deductible, Extra Help, and coverage stage. Always check your estimated drug cost before filling your prescription.
Q: Does Wellcare PDP cover GLP-1s?A: Wellcare Prescription Drug Plans (PDP) cover GLP-1 medications for FDA-approved medical uses, such as Type 2 diabetes. To know if your GLP-1 is covered, review our formulary.
Formulary (Drug list)
- Wellcare Classic Plan: 2027 Formulary
- Wellcare Value Script Plan: 2027 Formulary
Standard Medicare Part D plans do not cover these drugs if they are prescribed exclusively for weight loss.
For more information, visit: Does Medicare Cover Weight-Loss Drugs? Understanding GLP-1 Coverage in 2026.
Q: How do I get approved for GLP1 coverage?A: You must get prior authorization (doctor approval) to prove the medication is medically necessary for a qualifying condition.
Q: Are there Short-Term Weight Loss Options?A: If you are using a GLP-1 strictly for chronic weight management, you may be eligible for the temporary Medicare GLP-1 Bridge program beginning July 1st, 2026. This program is not part of your Wellcare plan. It is handled directly by Medicare and your doctor.
Q: What pharmacies can I use?A: To see preferred and standard pharmacies in our network, please visit our Find a Provider Tool.
A: Your plan may cover a medication but still have certain rules you need to follow before it is approved.
These rules may include:
- Prior authorization: Your plan must approve the drug before it is covered.
- Step therapy: You may need to try another drug first.
- Quantity limits: Your plan may limit how much of the drug is covered at one time.
These rules are set by your Part D plan and can vary by plan. This means a drug may be covered but you may still need approval before your plan pays for it.
Q: What types of medications may need a coverage request or exception?A: Your provider may ask your plan to cover a medication or make an exception to a coverage rule in certain situations.
This may include:
- A drug that is not listed on the formulary, or covered drug list
- A drug that may duplicate another therapy you are already taking
- A prescription that is higher than the FDA daily or monthly quantity limit
- Certain self-injectable or infusion medications
- A drug with an age requirement
- A drug that is listed on the Preferred Drug List but still needs prior authorization
- A brand-name drug when a generic version is available
- A drug with a step therapy rule when the first-choice drug is not right for you
Your provider can submit information to help explain why the medication is medically necessary.
Q: How can I submit a coverage determination if my medication requires a Prior Authorization (PA), Quantity Limit (QL), or Step Therapy (ST)?A: Below are the ways you or your provider can submit a coverage determination. Please note, we will need supporting information from your provider.
- You can ask your provider to submit digitally via an electronic prior authorization (ePA). Your provider must include statements supporting this request.
- Submit a request using our online form.
- You can print the form (PDF) and take it to your provider. The completed form can be submitted one of two-ways:
- Your provider can fax 1-866-388-1767.
- You or your provider can mail it to:
Pharmacy – Coverage Determinations
PO Box 31397 Tampa, FL 33631 - You may also ask for a coverage determination utilizing chat in our member portal or by phone at 1-888-550-5252 (TTY 711).
A: If you or your doctor request an exception, your plan usually decides within 72 hours. If waiting could put your health at risk, your doctor may ask for a faster decision within 24 hours.
If your request is denied, you can file an appeal, also called a redetermination.
Q: How can I pay my premium?A: There are many ways you can make your premium payment with us.
- Set up AutoPay or make a one-time payment through our secure online member portal.
- Deduction from your Monthly Social Security or Railroad Retirement Board Check
Call Member Services at 1-888-550-5252 (TTY 711) to get more information and set up these deductions. - Online with your Member ID and email address.
- By Phone: Call 1-888-550-5252 and select the billing option.
A: The Extra Help subsidy helps people who have limited income and resources to pay Medicare prescription drug program costs.
These costs are things like premiums, deductibles and co-payments/co-insurance. Depending on your income and resources, you may qualify for Extra Help.
Q: What is Extra Help? Do I qualify and how to apply?A: Extra Help is a Medicare program that helps people with limited income pay for prescription drug costs. It may help lower your monthly premium, deductible, and the amount you pay for covered medications.
Find out if you qualify for Extra Help. Call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week; TTY users may call 1-877-486-2048. Or apply online, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), or contact your state Medicaid Office.
Q: Who is Express Scripts®?A: Express Scripts® Pharmacy is our preferred mail order pharmacy partner. Members can use Express Scripts® to get certain long-term medications delivered to their home
Mail order is usually used for medications taken regularly for chronic or long-term conditions. Some medications are not available by mail. These drugs are marked “NM” for “not mailed” on your plan’s List of Drugs, also called a Formulary.
With Express Scripts®, you can:
- Order up to a 100-day supply ]of eligible medications, excluding Specialty Tier 5 drugs
- Get free standard shipping to your home
- Track your order online
- Request a prescription transfer from a retail pharmacy
- Speak with a pharmacist 24 hours a day, 7 days a week
You can usually expect to receive your medication within 10 to 14 days after Express Scripts receives your order. To help avoid delays, contact Express Scripts about 21 days before your current prescription runs out.
You can sign up for mail order:
- Online at express-scripts.com/rx.
- By phone at 1-833-750-0201 (TTY: 711), 24 hours a day, 7 days a week
- By mail using the Express Scripts Pharmacy mail order form at express-scripts.com/rx.
A: BuzzRx is a prescription discount program that may help members save money on medications not covered by their plan’s formulary.
There is no cost to use BuzzRx, and no sign-up is required. Members can check BuzzRx for possible discounts on non-covered medications at participating pharmacies.
Q: How can I access a temporary How can i access a temporary ID card Member ID card?A: Download and print a temporary ID card (PDF) you can use at your pharmacy. If you need to order a new member ID card, please login to the secure Member Portal at member.wellcare.com or call 1-888-550-5252 (TTY 711).
Q: What Is a Late Enrollment Penalty (LEP)?A: A Late Enrollment Penalty (LEP) is an amount added to your Medicare Part D monthly premium.
The cost of the Late Enrollment Penalty depends on how long you went without Part D or creditable prescription drug coverage. Members may owe a Late Enrollment Penalty for any continuous period of 63 days or more after their Initial Enrollment Period is over, or go without one of the following:
- Medicare Prescription Drug Plan (Part D)
- A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage
- Creditable prescription drug coverage (current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, CHAMPVA, or health insurance coverage)
When you enroll in a Part D plan it is important to provide information about prior coverage if you are not enrolling upon turning age 65. For additional information, visit wellcare.com/LEP.
A: A complaint is also called a grievance. You can file a grievance if you have concerns about the care or service you received, long wait times, or customer service. You can file a grievance yourself or have someone you trust file one for you.
Q: How can I file a grievance?A: You can file a grievance in one of the four following ways:
- Contact Us
- Write: Wellcare Health Plans, Inc.
Attn: Grievance Department
P.O. Box 31384
Tampa, FL 33631-3384
- Online: A grievance can also be submitted through the Contact Us Form. To access the Contact Us Form, select "Submit a question online" and follow the prompts.
- Fax: 1-866-388-1769
As a member of our plan, you have the right to file an expedited grievance (fast complaint) for specific circumstances:
- A member can request an expedited grievance only if the plan downgrades their expedited appeal or authorization to a standard; or if the plan takes an extension on an authorization or appeal, and the member disagrees.
If you are making a complaint because we denied your request for a “fast coverage decision" or "fast appeal", your complaint will be sent to the appeals team. After review, the appeals team will then forward your complaint to the grievance team to make a decision. If you have a fast complaint, we will give you an answer within 24 hours.
For more information, review our Grievances webpage.
A: You can sign up for a Medicare Supplement (Medigap) plan any time of the year, as long as you have Medicare Part A and Part B.
But, the best time to sign up is during a special 6-month period that starts when you’re 65 or older and have Part B. During this time, insurance companies can’t turn you down or charge you more because of your health.
If you apply after this time, insurance companies might:
- Ask about your health
- Deny coverage altogether because of your health
- Charge you more money
Some states have extra rules that help protect you, so it’s smart to check your state’s rules to see what options you have.
Q: I would like to get my medications (drugs) sent directly to my home. How to I sign-up to receive my prescription drugs and order refills through mail service delivery?A: You can fill your prescription at any network pharmacy. You can also fill your prescription through our preferred mail order service. This can save you time, money, and trips to the pharmacy.
Find more information about receiving your prescriptions through mail service delivery on the following Mail Order Service Page.
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 Us to find out more.
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 use your 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 Us right away, and we will send you a new card.
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: Can you change Medicare supplement plans with pre existing conditions?A: Yes, you can change your Medicare Supplement (Medigap) plan even if you have pre-existing conditions, but when you do it matters.
When you turn 65, you have a special 6-month period to sign up for Medicare Part B. During this time, insurance companies can’t say no to you or charge you more because of your health.
If you try to switch plans after that time, most companies can ask about your health. They might:
- Deny coverage due to pre-existing conditions like diabetes, asthma or cancer
- Charge you more money
- Make you wait up to 6 months before they cover your health problem
Some states have special rules that make switching easier, even after your first 6 months. Also, if you lose other coverage or move to a new area, you might have a right to switch plans without disclosing your health conditions.
It’s a good idea to check your state’s rules and talk to a licensed insurance agent before making changes.
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.
Q: What is a Medicare beneficiary identifier?A: Your Medicare Beneficiary Identifier (MBI) is a special code just for you. It’s made up of 11 letters and numbers, and doesn’t include any personal details like your Social Security number. This helps keep your information safe and lowers the chance of identity theft. You’ll find your MBI on your red, white, and blue Medicare card. You’ll use it for all things related to Medicare, like doctor visits, bills, and claims.
If you lose your card, you can ask for a new one online through your Social Security or Medicare account.
A: A network is a group of doctors and other health care professionals, medical groups, hospitals and other health care facilities that have an agreement with us to deliver 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: What is a qualified Medicare beneficiary?A: A Qualified Medicare Beneficiary (QMB) is someone who gets help paying for Medicare because they have a low income and few resources.
If you’re in the QMB program, it helps pay for:
- Your Medicare Part A and Part B monthly costs
- Deductibles
- Coinsurance and copayments
To qualify, you must meet income and asset limits set by your state. If you’re in the QMB program, doctors and other providers should not bill you for services covered by Medicare. You’ll also automatically get extra help to lower your prescription drug costs. To apply, contact your state’s Medicaid office to see if you qualify and how to sign up.
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 glossary located in your state's Medicare Basics page.
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: 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: 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 to call us and ask for an advance decision.
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: 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 Member Services representatives are ready to answer questions.
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: 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: Do Medicare beneficiaries have to pay for Medicare supplement plans?A: Most people on Medicare pay for parts of their coverage.
- Medicare Part A (hospital insurance) is usually free if you or your spouse worked and paid Medicare taxes for at least 10 years. But you might still have to pay for deductibles and/or coinsurance.
- Medicare Part B (medical insurance) costs money every month. You also pay a yearly deductible and part of the cost for services.
- If you choose prescription drug coverage (Part D), Medicare Advantage, or a Medicare Supplement plan, you’ll pay extra each month for additional benefits. In some cases, the additional benefits outweigh the costs.
Some people with low income can get help paying these costs through special programs or through Dual Eligible Special Needs Plans (D-SNP). It’s a good idea to look at your coverage and plan and consider your whole health and annuals needs. For questions on eligibility or choosing the right plan, reach out to us for assistance.
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.
A: Please complete our Become a Provider form or Contact Us for more information on how to join our network. If you want to join our Medicaid provider network, please be sure to visit your state-specific Medicaid website to submit a request.
Q: I forgot my Provider ID number. Where can I find it?A: Please check your Wellcare welcome letter. You can also use the Contact Us form for additional help.
Q: How do I check the status of a claim?A: To check claim status, log into the secure provider portal. The secure portal is for participating Wellcare providers that are contracted through Medicaid or Medicare lines of business.
Here are the steps to check a claim status:
1. Once you log into the secure provider portal, navigate to the Claims landing page.
2. Search for the claim in a variety of ways including: WCN Number, Claim Number, Member ID, Provider ID, Member Name and DOB, Medicare ID, Medicaid ID or DCN.
*Note: Certain items will require that you enter a date range under “Service Date”.
3. Select the “Search” button and the claim results will display below.
A: Yes. Wellcare Health Plans, Inc. is pleased to offer providers electronic funds transfer (EFT) and electronic remittance advice (ERA) services at no charge. Offered in partnership with PaySpan Health, you now have access to a secure, quick way to electronically settle claims. Using this no-cost service, providers can settle claims electronically, without making an investment in expensive EDI software.
You can find additional helpful information in your quick-reference guide.
A: Brokers interested in partnering with Wellcare may contact the Broker Support Call Center at 1-866-822-1339 (TTY 711) for further details.
Q: How do I get information about company health plans?A: To learn more about our combined product offering, what’s new and market-specific benefits, please visit Wellcare First Look.
Q: What If I need additional assistance or have questions?A: Wellcare is here for you! For support, brokers can contact our Broker Support Call Center, submit a Support Ticket online through Centene Workbench, our Single Sign-On broker portal, or reach out to dedicated local support.
Refer to our Sales Leadership Contacts list for local support.
Find additional Wellcare contacts with our Contacts and Resources page.
