Topics
- Magsimula
- Enrollment & Plan Changes
- Auto-enrolled Members
- Drug Coverage
- GLP-1s and the Bridge Program
- Pharmacies & Refills
- Coverage Determinations
- Costs, Premiums & Payment Options
- Ways to Save
- Express Scripts
- BuzzRx
- ID Cards & Account Access
- Late Enrollment Penalty
- File a Grievance
Magsimula
How can I enroll in Wellcare?
Here 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, October 1 through December 15, 7 days a week, 8:00 AM–8:00 PM. December 16 through September 30, Monday through Saturday, 8:00 PM.
- 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.
- How can I enroll in Wellcare Plan Enrollment Form - English (Coming Soon)
- How can I enroll in Wellcare Plan Enrollment Form - Spanish (Coming Soon)
How can I compare Wellcare plans?
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!
Enrollment and Plan Changes
When can I enroll or make a plan change into a prescription drug plan?
You can join switch or leave a prescription drug plan at these times:
- Initial Coverages 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.
- The Medicare Annual Enrollment Period is from October 15 to December 7, during this time you can:
- 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 could qualify for a Special Enrollment Period during any month when certain events happen in your life. Reasons you could qualify include:
Auto-enrolled Members
Why was I automatically enrolled in a Wellcare Medicare Prescription Drug Plan?
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
Drug Coverage
Are my prescriptions covered by Wellcare
To search for your medications you can view our online Formulary:
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.
What is a Formulary?
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.
You can find the Formulary online depending on your plan:
- 2027 Wellcare Classic Plan
- 2027 Wellcare Value Script Plan
- You can also download a PDF copy of your formulary:
- Visit our Find Your Plan tool.
- Select Prescription Drug Plan, your state, and your plan name.
- On the Plan Materials page, select Pharmacy.
- Select Drug List (Formulary) to download the PDF.
- 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 8 p.m. or April 1 and Sept. 30, Monday through Friday, from 8 a.m. to 8 p.m.
Does a higher drug tier mean I will pay more?
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.
GLP-1s and the Bridge Program
Does Wellcare PDP cover GLP-1s?
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)
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
Pharmacy and Refills
What pharmacies can I use?
To see preferred and standard pharmacies in our network, please visit our Find a Provider tool.
Coverage Determinations & Medication Approvals
What is Coverage Determination?
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.
What types of medications may need a coverage request or exception?
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.
How can I submit a coverage determination if my medication requires a Prior Authorization, Quantity Limit, or Step Therapy?
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 the chat in our member portal or by phone at 1-888-550-5252 (TTY 711).
What happens if I’m still denied the coverage I need?
If your request is denied, the denial notice will explain the reason for the decision and describe your appeal rights. Most decisions are made within 72 hours of receipt of information from your provider.
You have the right to ask the plan to reconsider its decision and may have additional levels of appeal available. If your request is denied, you can file an appeal, also called a redetermination.
Costs, Premiums & Payment Options
How can I pay my premium?
- 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 (TTY 711) and select the billing option.
Lowering Prescription Drug Costs
What if I am on a limited income or cannot afford my prescription drugs?
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.
What is Extra Help? Do I qualify and how to apply?
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.
Who is Express Scripts®?
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.
Most mail-order prescriptions must be written for at least a 35-day supply. Eligible medications may be dispensed for up to a 90-day supply (excluding Specialty Tier 5 drugs), based on your prescription and plan coverage.
With Express Scripts®, you can:
- Order up to a 90-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
Who is BuzzRx?
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.
Keep in mind that medications purchased using BuzzRx® are not processed through your prescription drug plan. Because of this, the amount you pay will not count toward your Medicare Part D deductible or out-of-pocket drug costs.
Member ID Cards & Account Access
How can I access a temporary Member ID card?
Download and print a temporary ID card (PDF) you can use at your pharmacy.
How can I request a replacement Member ID card?
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).
Late Enrollment Penalty
What is a Late Enrollment Penalty?
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.
File a Grievance
What is a grievance?
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.
How can I file?
Puwede kayong maghain ng karaingan sa isa sa mga sumusunod na apat na paraan:
- 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.
