By Carol Gentry
2/24/2009 © Florida Health News
WellCare drug-plan members left reeling from last week's federal crackdown on the Tampa company are not stuck in WellCare for the rest of 2009, after all. They have options.
Medicare officials did not make that clear until Monday afternoon, after Florida Health News questioned remarks an official made last week.
(Editor’s note: We’re not saying WellCare members should leave, we’re just saying they can if they want to).
Late last week, Medicare officials announced they were freezing WellCare’s enrollment of Medicare beneficiaries as of March 7 because the Tampa company had the highest complaint ratio in the country, three times the national average. On Friday, Medicare spokesman Peter Ashkenaz told some Florida newspapers that members of WellCare drug plans were pretty much stuck there for the duration of 2009 because the period for switching drug plans ended Dec. 31.
After consulting with Florida Health News insurance columnist Robert Archer, whose column appears on the Consumer Corner page, I contacted Ashkenaz. On Monday afternoon, he conceded the mistake.
Here’s the straight scoop, according to Archer:
Members of a WellCare Medicare Advantage plan that includes prescription drug coverage, which most of them do, can switch to a similar plan sponsored by a different company, such as Humana or United. Or they can go back to original Medicare and choose a drug plan sponsored by another company.
"All they have to do is call them, saying 'I would like to join your plan.' That’s the simplest way to do it,” Archer said.
Medicare beneficiaries who have extremely low incomes -- so-called "dual eligibles," who qualify for coverage under both Medicare and Medicaid -- can switch plans any time they want and aren't governed by the usual sign-up periods. The following information applies to others:
If they're in a WellCare drug plan with everything else covered by original Medicare -- a rare situation, at least in Florida, Archer says -- they can’t just switch from one drug plan to another. But they’re not stuck. They can sign up for another company’s Medicare Advantage plan, as long as it has prescription drug coverage included.
If they're absolutely dead-set against managed care, the only way to switch from one drug plan to another before the end of the year is to persuade a Medicare hotline operator and case manager that they can’t get the drugs they need and it's hurting their health.
Now, are we clear?
It’s a shame that Medicare regulations are so complicated, says Paul Precht of the Medicare Rights Center. “This whole system they have where people are locked in for a year does not work for most people,” said Precht, director of policy and communications for the non-profit advocacy group.
The WellCare situation was especially unfair, he said, since Medicare officials didn't offer drug-plan members a special-enrollment period based on the violations the company committed (see coverage of the allegations.)
“The company performed badly enough that people who are now in WellCare should be able to get out if they want to,” Precht said.
--Contact Carol Gentry by e-mail or phone, 727-410-3266.