Wellcare Weekly News

‍Inflation Reduction Act Impacts - Part D Cost-Sharing Updates and SEP

Effective January 1, 2023, the Inflation Reduction Act (IRA) will be in effect for all Medicare beneficiaries. The IRA was introduced October 2022 and provides cost-share reductions to assist Medicare beneficiaries with their Part D drug expenses. The following updates will be reflected for plan year 2023:

• Covered insulins will be capped at $35 per fill for a 30-day supply.
• Part D vaccines (flu, shingles, pneumonia, COVID-19 etc.) will be $0.

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‍‍‍Why is this important?

Prior to October 1, 2022, the CY2023 Medicare Plan Finder (MPF) reflected insulin and vaccine benefits as they were submitted in the 2023 bid and formulary submissions, prior to the IRA being instated, therefore did not reflect    these updates. CMS is updating the MPF to include new insulin and vaccine drug footnotes and other help features to explain the benefit changes resulting from the IRA. Therefore, some Part D coverage may not be accurately reflected on the MPF.

What should you do if the insulin copays are not reflecting correctly during the application process?

If you are aware that your member is currently on an insulin regiment and should have access to the updated cost-sharing from the new IRA update, inform the member that they will not pay more than $35 for covered insulins nor more than $0 for covered vaccines. Members will experience correct cost-share at the point of sale, so should not need to seek reimbursement.

Special Enrollment Period

Due to the MPF inaccuracies, CMS is granting a Special Enrollment Period (SEP) for Exceptional Circumstances to allow members to add, drop, or change their Part D coverage if they find a better option after the 2022 Annual    Enrollment Period (AEP) through the end of 2023. This SEP will be available for all beneficiaries who use a covered insulin product and begins on December 8, 2022 and ends on December 31, 2023. Beneficiaries may use this SEP one time during this period. To utilize this SEP, beneficiaries must call 1-800-MEDICARE so a customer service representative can process the enrollment change.

Additionally, Wellcare’s Senior Savings Model (SSM) program is still in effect for plan year 2023 and will provide the same benefits as the IRA program. Both Part D benefits are designed to help reduce out-of-pocket expenses for members who use insulin. All insulins and insulin-combination products that are on the formulary, regardless of tier, are included in the $35 cap for one month’s supply. While both programs cap member copay for insulin at $35 per    month, some SSM plans may offer lower copays on select insulin drugs compared to IRA.

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Envolve Dental Partnership With  United Concordia

Wellcare’s dental benefits are administered through Envolve Dental. Envolve operates networks with over 76,000 dental service providers and their network of dentists continues to grow. To ensure Wellcare members have access to  in-network providers close to home, Envolve Dental has partnered with United Concordia (UC), expanding their network of dental providers through a leased  network.

What does this mean for your members?

It is important that when your member schedules a dental appointment, that they tell the dental office they have dental coverage with Envolve Dental who has a leased network through United Concordia. Envolve Dental is the Dental  Benefits Manager for your member’s dental plan and this explanation will  alleviate any branding confusion and denial of service.

Where can your members find an  in-network provider?

In-network dental providers, through Envolve Dental and United Concordia, can be found using the Wellcare Find-a-Provider tool.                                  

What if your members need further  assistance with their dental coverage?

If members need assistance with their dental care, they may call the Envolve Dental  phone number located on the back of their Plan Year 2023 Member ID card.

Wellcare  is focused on simplifying the healthcare experience for our valued Medicare  members. We understand that dental is an important part of our member’s  healthcare; therefore Envolve Dental, in partnership with United Concordia  and as your member’s Dental Benefits Manager, is here to assist with any  dental needs.

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2023 Prior Authorization Clarification - Nebraska

Please be aware that prior authorizations are not required to see a Specialist.  However, some services ordered by Specialists, as well as PCPs, may require authorization. Examples include sleep studies, pain management procedures, bariatric surgery, orthopedic surgery, some cardiac procedures, and others.

 For more information, members should consult their Evidence of Coverage. It is always best to make sure the physician is coordinating with the plan to ensure any required authorizations are obtained prior to performing services