Wellcare Weekly News: Important Enrollment Guidelines & PPO

This week, Wellcare focuses on some important enrollment guidelines and spotlight their PPO product.

• Medicare Advantage Open Enrollment Period (MA OEP) - Highlighting important enrollment guidelines for MA OEP
• Special Enrollment Period (SEP) - Highlighting CMS guidelines for placing SEP enrollment requests correctly
• Preferred Provider Organization (PPO) plans - Providing greater flexibility and control to our members

Medicare Advantage Open Enrollment Period (MA OEP)

With less than a month before the close of the Medicare Advantage Open Enrollment Period (MA OEP), Wellcare wanted to highlight some important points concerning MA OEP guidelines:

• MA OEP will end on March 31, 2022.
• During MA OEP, members can make a one-time change to their MA or MAPD plan or return to Original Medicare. One-time change means members can either enroll into a plan or disenroll from a plan. If a member disenrolls from a plan with the intention of enrolling into another plan, their application will be denied as the disenrollment counted towards the one-time change.
• Important: You are encouraged to advise members to enroll to their desired plan during MA OEP. Enrollment to a new plan will automatically trigger their disenrollment from their current plan.

Please refer to the previous email communication on MA OEP for more guidelines on this topic.

Special Enrollment Period (SEP)

Wellcare continues to receive SEP enrollments even when a valid SEP is not available for the member. As a reminder, SEPs are election periods outside of IEP, AEP and MA OEP where a qualifying individual may enroll into or disenroll from a plan, or change their current plan election. Please note the following SEP guidelines stated below:

• There are various types of SEPs, each with specific eligibility criteria, time frames and effective dates. Please ensure that these are fully met before placing a SEP enrollment request.
• An individual might be eligible for a SEP, but would also have to meet the eligibility criteria of the plan selected for enrollment.
• Unless stated otherwise, an individual meeting the SEP and plan eligibility criteria can only make a one-time change to their plan election.
• The SEP for the individual ends when the individual elects a new plan or when the SEP time frame ends, whichever comes first, unless specified otherwise within a SEP.

You are encouraged to view the SEP section in the CMS Enrollment and Disenrollment Guidance for Medicare Advantage (MA) (Section 30.4) and/or Prescription Drug Plan (PDP) (Section 30.3) for detailed descriptions of the various types of SEPs and their eligibility criteria.

Preferred Provider Network (PPO) Plans

In an effort to help its members live better, healthier lives, Wellcare strives to create a wide variety of Medicare Advantage (MA) plans tailored to fit different healthcare needs. Its Preferred Provider Organization (PPO) plans are MA plans that put the members in the driver’s seat. They provide more flexibility and control by giving members the option to select doctors, hospitals and other health care services that are not in the plan’s network.

PPO Plan Offerings:

• Wellcare PPO plans are marketed as Wellcare Open plans and are available in 35 of our Medicare markets (PPO plans are not available in Wisconsin)
• Ascension Complete PPO plans are marketed as Access and Access Plus plans and are offered in Alabama, Indiana, Kansas, Michigan, Tennessee and Texas.

Be sure to visit the PPO Resources Page for helpful information on Wellcare PPO plans and to learn how Wellcare administers this valuable product option for its members.