In late December I received this email from a client regarding their Wellcare PDP plan.
My wife got a call from a Wellcare salesman in October trying to sell her on Medicare Advantage. She said NO, but somehow Wellcare decided it was better for her Part D (drug coverage) to be changed to their Medicare Advantage plan. So they changed it WITHOUT her knowledge or approval.
1. How do we get it back to the way it was? OR
2. Even better, how does she change her plan to another company since she doesn't trust Wellcare? They said open enrollment is
from Jan 1 - March 31. (This is a special Open Enrollment for folks on Medicare Advantage plans only. It does not apply to those with stand alone Part D coverage).
3. Has this affected her regular Medicare? and/or Part B? She wants to continue with traditional medicare and the Supplement she's already on.
She called Wellcare and spoke with the plan that was canceled as well as the new plan. They say she has to re-enroll even though it was their error.
Needless to say, she is very upset and stressed by
this and wants it resolved as soon as possible.
Thanks for your help.
My client received a letter (dated 12/8/2023 AFTER the close of Open enrollment) from Wellcare
stating she would be enrolled in their HMO Advantage plan as of 1/1/2024 and she was assigned to a network PCP.
My advice is to contact the MBO (Medicare Beneficiary Ombudsman) via 1-800-MEDICARE.
The MBO helps you with Medicare-related complaints, grievances, and information requests. The MBO makes sure you have information related to your Medicare rights and protections and how you can get your concerns resolved.
I am penning this newsletter on January 2, 2024. At this point my client’s problem is not resolved and we have no idea how long the process will take or if the change will be retroactively effective to 1/1/2024 or not.
My suggestion is for the lady to reschedule any non-critical tests or procedures for January (when possible). Until this is resolved any medical and drug claims for January will be filed with the Wellcare HMO, not Medicare.
She will also need to pay her January Medigap premium, even though claims filed with the HMO will not be covered by original Medicare or her supplement plan. Failure to pay the January premium will result in a lapse of coverage. If that happens she may not be able to reinstate her Medigap plan, or possibly be blocked by other carriers where she could apply.
If the MBO is unable to fix the problem retroactively to January 1, the alternative is to enroll her in a different drug plan with a February effective date. Doing this will terminate her HMO as of 1/31 and restore original Medicare effective 2/1/2024.
This will make her “whole” again with original Medicare, Medigap and PDP but that leaves any January claims on the HMO.
Keep in mind this situation was initiated and created by Wellcare. My client did not want to change to an Advantage plan but was tricked
by an agent that represents Wellcare.