WellCare Dual Eligible Plans 2025

Seeking updated WellCare dual eligible plans for 2025? Find comprehensive information on the newest WellCare D-SNPs, essential for individuals dual-eligible for Medicare and Medicaid.

This guide covers the standout changes and benefits of the WellCare Dual Eligible Plans 2025, elucidates eligibility requirements, and walks you through the streamlined enrollment process.


Key Takeaways


  • Enrollment in WellCare D-SNPs requires one to be covered by both Medicaid and Medicare, with enrollment possible anytime outside the Annual Enrollment Period. WellCare offers additional support services such as in-home care, wellness programs, and $0 copays on common medications for eligible members.


  • WellCare D-SNPs include comprehensive formularies for medications, and support for insulin costs through the Part D Senior Savings Model and require a primary care provider to coordinate personalized care. Added benefits include dental, vision, and over-the-counter medication coverage, with the option for members to receive cash back monthly to assist with Medicare Part B premiums.

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Understanding WellCare Dual Eligible Plans for 2025

WellCare’s Dual Eligible Special Needs Plans (D-SNPs) are specifically designed for individuals who qualify for both Medicare and Medicaid. These plans offer comprehensive coverage that caters to their unique needs, creating a seamless healthcare experience.

For 2025, WellCare has upped the ante by introducing 23 newly designed plans. These include new D-SNPs that aim to provide even more enhanced coverage for dual-eligible members.

A notable feature of WellCare’s D-SNPs is the inclusive plan that covers pharmacy benefits. This means that members do not need to choose a separate Part D plan, simplifying their healthcare journey.


The Advantages of Choosing a WellCare D-SNP


WellCare Dual Eligible Plans 2025, The Advantages of Choosing a WellCare D-SNP


There’s no denying that WellCare D-SNP plans to offer an extensive array of benefits. Beyond the original Medicare, these plans deliver comprehensive additional support at no extra cost for eligible dual members. But that’s not all.

Members also have access to preventive services through their health insurance at no additional cost, which includes annual wellness visits and flu shots, paving the way for a proactive approach to health management.

In addition to these benefits, some individuals may also be eligible for Medicaid services, further expanding their healthcare options.


Enhanced Prescription Drug Coverage

One of the key advantages of WellCare D-SNP plans is the enhanced prescription drug coverage. This outstanding feature can lead to significantly lower out-of-pocket costs for medications, making health management more affordable.

Imagine having $0 copays on many commonly used medications, including generics. With WellCare D-SNPs, this is a reality, designed to make prescription drugs more accessible to members.

Beyond the cost benefits, WellCare D-SNP plans also boast a comprehensive formulary that covers a wide range of prescription medications. This ensures that members with various health conditions have their medication needs met.

Moreover, qualifying for a WellCare D-SNP could also mean eligibility for the EXTRA HELP program, a cost-support initiative for prescription drugs.


In-Home Support Services and Wellness Programs

WellCare D-SNP plans to understand the importance of holistic care. That’s why these plans often include:

  • In-home support services to assist members with daily activities and healthcare needs


  • Meals delivered at home following a hospitalization


  • Access to a personal emergency response system for round-the-clock emergency assistance


With WellCare D-SNPs, this level of personalized care is a standard offering.

But the support doesn’t stop there. Members can also take advantage of the following wellness and fitness programs, designed to maintain, and improve health through WellCare health insurance:

  • Interactive health and wellness tool on the WellCare website



  • Dental services


  • Telehealth services


These benefits ensure comprehensive health support.


Vision and Dental: The Overlooked Essentials


WellCare Dual Eligible Plans 2025


Often overlooked, dental and vision coverage are essential parts of holistic health management. Recognizing this, WellCare D-SNPs include these as part of their coverage, offering services that are often not provided by original Medicare.

Dental coverage includes preventive services like exams and cleanings, as well as comprehensive services such as x-rays, fillings, extractions, dentures, and certain restorative and prosthodontic services.

In terms of vision coverage, WellCare D-SNPs cover annual eye exams and provide allowances for glasses or contact lenses. The inclusion of these often-overlooked essentials underscores WellCare’s commitment to providing comprehensive healthcare coverage that addresses the full spectrum of beneficiary needs.

Enrollment and Eligibility Criteria for WellCare D-SNPs

To enroll in a WellCare D-SNP, individuals must meet certain eligibility criteria. Primarily, they must:

  • Be covered by both Medicaid and Medicare


  • Qualify for Medicare, which generally involves being 65 years or older, or being under 65 with a qualifying disability, ESRD, or ALS


  • Adhere to federal Medicare requirements and Medicaid criteria specific to their state to qualify for a WellCare Dual Special Needs Plan (D-SNP)


The good news is, that dual eligible individuals for Medicare and Medicaid can enroll in a D-SNP at any time, without having to wait for the Annual Enrollment Period (AEP). Assistance for enrolling in WellCare plans is just a phone call away.

By dialing their enrollment hotline at 1-844-599-0139, operating from 8 a.m. to 8 p.m., seven days a week, prospective members can get all the help they need to navigate the enrollment process and access the Medicaid provider directory.


Comparing WellCare D-SNPs with Other Providers


WellCare Dual Eligible Plans 2025


In the world of healthcare, every individual has unique needs, and it’s critical to find a plan that best caters to these needs. When compared with other providers’ D-SNP plans, WellCare D-SNPs offer additional support and benefits at no extra cost, providing a more comprehensive solution.

Unlike some Medicare Advantage plans from other providers, WellCare D-SNPs include pharmacy benefits as part of the network. This means that enrollees don’t have to select a separate Part D plan, simplifying their healthcare management.

Cost is another factor where WellCare D-SNPs shine. These plans often have $0 monthly premiums, a benefit that might not be as common among other providers. WellCare goes a step further by providing give-back plans.

These offer cash back monthly to assist with paying the standard Medicare Part B premium, a potentially more generous offering than what other providers’ plans may entail.

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Navigating Costs with WellCare Medicare Advantage Plans


WellCare Dual Eligible Plans 2025, Navigating Costs with WellCare Medicare Advantage Plans


Managing healthcare costs can be a balancing act. However, with WellCare Medicare Advantage plans, this task becomes less daunting. These plans offer a variety of monthly premiums that can range from $0 up to about $60, catering to a wide range of budgetary needs.

While members enrolling in a Medicare Advantage plan with a $0 monthly premium enjoy no additional premium for their plan, they are still responsible for the standard Medicare Part B monthly premium.

WellCare’s Medicare Advantage plans, also known as WellCare Medicare Advantage Plan, offer the financial safety of a low out-of-pocket maximum.

This ensures that annual expenses for covered healthcare services are capped, protecting members from high medical costs. Additionally, eligible members of WellCare D-SNP plans may incur reduced costs for insulin, sometimes as low as $35 or less, through the Part D Senior Savings Model.


Personalized Care Coordination

When it comes to healthcare, one size doesn’t fit all. Recognizing this, WellCare D-SNPs require members to choose a Primary Care Provider (PCP) to handle the coordination of their care.

The selected PCP gets to know the health needs of the member, ensuring a seamless integration of all enhanced benefits and services provided by WellCare D-SNPs to support the member’s health effectively.

PCPs play a pivotal role in the health management of dual-eligible members. They oversee medication reviews and utilization when necessary, ensuring that members get the right medications at the right time. Beyond this, members can avail themselves of additional support, including collaboration with a medical director or pharmacy department for medication reviews under the WellCare Model of Care.

To top it all, WellCare D-SNP members have access to a 24-hour Nurse Advice Line, offering clinical assessments and medical advice at any time.

Accessing Resources and Support


WellCare Dual Eligible Plans 2025, Accessing Resources and Support


With WellCare D-SNPs, members are never alone in their healthcare journey. Support and resources are always within reach. Members may receive medication reviews and utilization assessments as part of their plan’s Model of Care, where a medical director and/or the Pharmacy department can aid if needed.

Contracted providers with WellCare are prohibited from balance billing D-SNP members held harmless by the state for Medicare Part A and Part B covered services, as mandated by CMS requirements.

Claims for reimbursement vary depending on the state’s arrangement, and providers should refer to the Provider Manual, Section 14, Dual-Eligible Members, for the appropriate process.

Plus, WellCare D-SNPs offer a deeming period of up to six months during which D-SNP members who lose their Louisiana Medicaid benefits can remain in the plan while they try to regain their Medicaid eligibility and access their Medicaid benefits.

Tailoring Your Plan: Additional Coverage Options

WellCare D-SNPs are not just about covering the basics. They go beyond offering enhanced benefits and services designed to fit together for a more personalized healthcare experience. For instance, the My WellCare Rewards Program incentivizes members with gift cards for completing qualified healthy behaviors.

In addition, some WellCare D-SNP plans, including WellCare prescription insurance, offer coverage for over-the-counter medications and health items. This augments the plan’s prescription drug benefits, providing a more comprehensive coverage for members.

Transitioning to WellCare D-SNPs: Steps and Considerations


WellCare Dual Eligible Plans 2025


Transitioning to WellCare D-SNPs involves a few steps and considerations. First and foremost, individuals must understand the eligibility criteria.

To enroll in a WellCare D-SNP, individuals must qualify for both Medicaid and Medicare coverage. They also need to select a primary care physician (PCP) as D-SNP plans require a designated PCP to coordinate care.

Potential members also need to consider the additional coverage options. Being eligible for a WellCare D-SNP may also make you eligible for the EXTRA HELP program. This program provides cost support for prescription drugs. It’s also important to note that it’s not possible to choose a separate Part D plan with a Medicare Advantage D-SNP plan since the included pharmacy benefits are part of the network.

Ultimately, transitioning to a WellCare D-SNP includes the advantage of selecting a primary care provider who understands the individual’s health needs and coordinates their care with other providers. Plus, additional support and benefits at no extra cost are included in WellCare D-SNPs for those who are dual-eligible for Medicaid and Medicare.


To wrap up, WellCare’s Dual Eligible Special Needs Plans (D-SNPs) offer a comprehensive healthcare solution for individuals eligible for both Medicare and Medicaid. With enhanced prescription drug coverage, in-home support services, wellness programs, and essential vision and dental coverage, these plans aim to provide a personalized healthcare experience.

Whether you’re comparing plans or transitioning to WellCare D-SNPs, it’s important to consider the unique benefits and additional coverage options that WellCare offers.


Frequently Asked Questions


  What are WellCare’s Dual Eligible Special Needs Plans (D-SNPs)?

WellCare’s Dual Eligible Special Needs Plans (D-SNPs) are designed for individuals who qualify for both Medicare and Medicaid, offering comprehensive coverage tailored to their specific needs.


→  What are the benefits of WellCare D-SNPs?

WellCare D-SNPs offer benefits such as enhanced prescription drug coverage, in-home support services, wellness programs, and essential vision and dental coverage, providing comprehensive care for members.


  What eligibility criteria do I need to meet to enroll in a WellCare D-SNP?

You need to be covered by both Medicaid and Medicare to enroll in a WellCare D-SNP.


→  How does WellCare D-SNP compare to plans from other providers?

WellCare D-SNPs provide extra support and benefits at no extra cost compared to some plans from other providers, with $0 monthly premiums and give-back plans offering monthly cashback to assist with paying the standard Medicare Part B premium.


 What additional coverage options does WellCare D-SNP offer?

WellCare D-SNP offers coverage for over-the-counter medications and health items and provides the My WellCare Rewards Program, which rewards members for completing healthy behaviors.

This can provide additional options for managing your health needs effectively.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.