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New Member Frequently Asked Questions

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Common Medicare Questions
How to Search my Provider Network and Pharmacies
Specialist & Referral Questions
Questions about Member Materials or Documents
Transition & Continuation of Care Questions
Member Portal / My Wellcare App Questions
Pharmacy Questions
Over the Counter (OTC) Questions 

Common Medicare Questions

네트워크란?

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.

빨간색, 흰색 및 파란색 Medicare 카드를 계속 보관해야 하나요?

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, 연락 정보 right away and we will send you a new card.

내 WellCare 플랜이 마음에 들지 않는다면 Original Medicare로 돌아갈 수 있나요?

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.

서비스를 받기 위한 허가를 어떻게 받을 수 있나요?

You can get service authorizations from you primary care provider (PCP) or from specialists you're referred to.

Will I have the same coverage as I do with original Medicare?

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.

응급 진료를 받을 수 있습니까?

You have the right to emergency care, when needed, anywhere in the United States and without pre-approval from us.

Do HMO or HMO POS plans cover services that Medicare does not consider medically necessary?

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.

What do I need to do to get care?

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.

What happens if my doctor is not familiar with Wellcare Medicare Advantage Plans?

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.

Can Wellcare ever drop my coverage?

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.

What if I need to talk to a nurse?

One of the perks of being a Wellcare member is our 24-hour Nurse Advice Line at 1-800-581-9952. (TTY 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.

Do I still have to pay my Medicare Part B premium?

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.

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Still have questions? Contact Us. We are happy to help!

 

How to Search my Provider Network and Pharmacies

How do I look up my in network provider or pharmacy on your website?

Visit our Find a Provider page.

  • Enter your Zip Code
  • Enter Coverage Type
  • Select Corresponding Plan
  • Select "Where you want to search"
  • Enter "What you are looking for" (ex. Pharmacy) or Choose a Specialty
  • Click "Go to results"

How do I look up pharmacies near me?

Use our Find a Provider tool or download our Wellcare+ Mobile App to access these feature at your fingertips!

Pharmacy Finder

  • Members can search by zip code or allow the app to use their current location.
  • Once location is determined, you can select "Map View" in the top right-hand corner to get a visual of the actual location.
  • Tap on a pin location to view Pharmacy Details.
  • You also have the option to access our "Drug Cost Lookup" feature to determine the cost of your prescription and identified if it is a covered prescription.

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Still have questions? Contact Us. We are happy to help!

 

Specialist and Referral Questions

I have a PPO plan. I would like assistance with confirming if a referral is preferred by my new specialist.

With your PPO plan, you have the freedom to choose doctors, specialist and hospitals that are not in network. Your plan does not require a referral to see specialists, but please keep in mind that some specialists may request one. If you would like assistance in confirming if a referral is preferred by your new specialist, please give us a call and we can contact their office to confirm that they are willing to accept our plan for you and to advise them that your plan will not require a referral.

I have a PPO plan. My new specialist is insisting on a referral. What should I do?

With your PPO plan, you have the freedom to choose doctors, specialist and hospitals that are not in network. Your plan does not require a referral to see specialists, but please keep in mind that some specialists may request one. You can call your PCP office and advise them that even though you have a PPO plan, your specialist is requesting that your PCP fax over a referral order. Alternatively, you can call us and we can assist you with this process.

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Still have questions? Contact Us. We are happy to help!

 

Questions about Member Materials or Documents

I am a new member. When will I receive my ID card?

You will receive your ID card in the mail within 10 calendar days from receipt of CMS confirmation of enrollment or by last day of month prior to effective date, whichever is later.

You can also download our Wellcare+ Mobile App to have your ID card at your fingertips.  It's free to download in the App Store® and Google Play™. Create your account to get started.

I am a new member. When will I receive my Welcome Kit?

You will receive your Welcome Kit in the mail within 10 calendar days from receipt of CMS confirmation of enrollment or by last day of month prior to effective date, whichever is later.

I am a new member. I have recently selected a new PCP and submitted a PCP change. When will I receive a new Member ID card in the mail with my updated Primary Care Physician?

Upon submitting your request for a PCP update, you will be receiving a new Member ID card in the mail with your updated Primary Care Physician within 7-10 business days at the address on file. Should you need your card sooner, you may log on to the member portal to print a temporary ID Card. 

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Still have questions? Contact Us. We are happy to help!

 

Transition and Continuation of Care Questions

I am a new member and I have an existing relationship with a provider who is not part of the Wellcare provider network. What should I do?

If you have written documentation of prior authorization, Wellcare will honor ongoing covered services by the non-participating provider for a period after the effective date of enrollment. A non participating provider can submit a previously approved authorization to Wellcare Authorization Intake for continuity of care during the member's Transition of Care period.

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Still have questions? Contact Us. We are happy to help!

 

Member Portal / My Wellcare App Questions

What information do I need to register for an account on the portal or Wellcare+ Mobile App?

Members can register for an account by taking the following steps:

  1. Enter the following information
    • First and Last Name
    • Date of Birth
    • Member ID
    • Valid email address
  2. Agree to the terms and conditions
  3. Create a secure password

What are the main features of my Home Page on the portal?

The Home Page allows you to do any of the following:

  • Print a temporary/request a new ID card
  • Change a primary care provider
  • Make a Payment (where applicable)
  • Contact a nurse through completing a form, which is submitted to the Nurse Advice Line (Envolve People Care)
    • A clinical nurse will review the request and respond within 24 hours of the initial request
  • Send a secure message to the health plan
    • Health Plan Member Services Department staff responds to all requests within one business day]
  • My Benefits
    • Provide you with benefit and financial responsibility for a specific service or treatment from a specified provider or institution, if applicable
    • This information may be available through the Cost Estimator tool - (Marketplace Only)
  • Let Us Know (About Your Health) for access to submitting and/or viewing member health assessments
  • Reward Program for viewing member rewards account balance and activity

What does the Wellcare+ mobile app allow me to do?

Wellcare members can keep up with health benefits and ID Cards, find a provider and more. If you are a Medicare or Prescription Drug Plan member, you can download the Wellcare+ app to get all the same helpful tools and more. This includes drug claim history and drug cost lookup.

I have a Wellcare Medicare Advantage plan. What features can I access through the Wellcare+ App?

The following features are available to you through the Wellcare+ App:

  • 서비스 제공자 찾기
  • Pay Your Premium
  • Quick Care (search for Urgent Care facilities)
  • Appointments (future and past appointments scheduled for you by Wellcare)
  • Wellness Services (listing of your open care gaps)
  • Change PCP (if applicable)
  • Update Contact Information
  • Care Plan (if applicable)
  • ID Card
  • Messages
  • About Us
  • 연락 정보

Features available for members who have prescription drug coverage through Wellcare:

  • Drug Cost Lookup
  • Drug Claims History

Am I able to view my Member ID card through the Wellcare+ App?

Yes. Members can view, download, print and fax the front and back of their ID Card.

What information do I need to have on hand to register for the Wellcare+ App?

You will need to have the following information on hand to register for the Wellcare+ App:

  • Member/ Subscriber ID or Medicare ID
  • First Name and Last Name
  • Date of Birth

I already registered online through the Member Portal? Do I need to create a new login for the Wellcare+ App?

Members who have already registered from within the online Member Portal will be able to use their existing Member Portal ID and password to login to their Wellcare+ App.

I previously registered for the Wellcare+ App but forgot my password. What should I do?

To reset your password you will need to follow the following steps:

  • Select ‘Forgot Password’ and you will be navigated to the Forgot Password screen.
  • You will then need to answer the questions you previously selected during your registration process
  • Upon correctly answering all questions, a message will then display indicating that a temporary password has been sent to your email. Your new temporary password will then be emailed to the email address we have in our records, and you will be required to change it when you log into the application
  • One your temporary password is retrieved from your email, you will need to return to the Wellcare+ App and click OK on the message.
  • After selecting "Ok", you will be navigated to the "Reset Password" screen to input your temporary password as well as create a new password
  • Passwords must include at least 3 of the following:
    • Uppercase letter
    • Lowercase letter
    • Number or special character
  • Once you have set up your new password, a message will display indicating that your password has been updated

Can I complete my Health Questionnaire through the Wellcare+ App?

Yes. The questionnaire will open outside of the app, displaying within your default browser.

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Still have questions? Contact Us. We are happy to help!

 

Pharmacy Questions

Can I submit a reimbursement request on a covered drug?

Yes. Reimbursement requests must include the following:

  • Cash Register Receipt
  • Prescription Receipt Including:
    • Patient Name
    • Date of Fill
    • Day of Supply
    • Prescription Number
    • Quantity Dispensed
    • Pharmacy Name and Address
    • Drug NDC Number
    • Total Amount Paid

Where do I submit a reimbursement request on a covered drug?

Requests can be submitted to the address & fax number below:

  • Member Reimbursement Fax Number: 1-888-481-7921
  • Member Reimbursement Mailing Address:
    • Medicare Part D Pharmacy Claims
      Attn: Member Reimbursement Departments
      P.O. Box 31577
      Tampa, FL 33631-3577

How do I look up pharmacies near me?

Download our Wellcare+ Mobile App to access these features at your fingertips! It's free to download in the App Store® and Google Play™.

  • Pharmacy Finder
    • Members can search by zip code or allow the app to use their current location.
    • Once location is determined, you can select "Map View" in the top right-hand corner to get a visual of the actual location.
    • Tap on a pin location to view Pharmacy Details.
    • You also have the option to access our "Drug Cost Lookup" feature to determine the cost of your prescription and identified if it is a covered prescription.

I would like to get my medications (drugs) sent directly to my home. How do I sign-up to receive my prescription drugs and order refills through mail service delivery?

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 Express Scripts® Pharmacy Mail Order Service page.

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Still have questions? Contact Us. We are happy to help!

 

Over the Counter (OTC) Questions

I was told I have an OTC benefit, what is that?

An OTC benefit is an Over-the-Counter Benefit. This valuable benefit provides a monthly or quarterly allowance on your Wellcare Spendables card for a variety of OTC items, such as cold medicine, allergy and sinus, dental and oral health, first aid supplies, vitamins, and more. 

How can I obtain my OTC benefit?

There are four easy ways to order your OTC items:

  1. In-Store:      
    • Visit a participating retail store location and use your Wellcare Spendables card.
    • At checkout, have the cashier scan the back of your Wellcare Spendables card.
    • If applicable, you can pay any remaining balance with an alternate form of payment method.
  2. Mobile App:
    • Go to the Healthy Benefits+ website or HealthyBenefits+ mobile App and download the application.
    • Scan product barcodes using the mobile app while shopping at participating retail stores for eligible product.
    • At checkout, have the cashier scan the barcode on the mobile app.
  3. Online:
    • Login to your Member Portal. From the member portal, log into the Healthy Benefits Plus web portal.
    •  Review the online catalog.
    • Click on Shop Online page.
    • Add the OTC items to your cart, enter delivery address and place your order.
  4. By Phone:
    • Review catalog.
    • Call toll free number at: 1-855-744-8550 (TTY 711).
    • Place your order with a customer service representative.

Where can I find the catalog?

Wellcare Spendables welcome packet will be mailed automatically upon plan enrollment. If your plan has an OTC benefit, the welcome packet will come with a copy of the catalog. You can also view or download a copy of the catalog online or on the Healthy Benefits + mobile app.

If I don't use all of my allowance, will it roll over?

Depending on your plans benefits, your OTC Benefits may or may not roll over. Please check your plans benefits for verification.

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Y0020_WCM_134133E Last Updated On: 10/1/2023