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2016 Medicare Prescription Drug Plan Benefit Details for the WellCare Simple (PDP)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2016 Medicare Prescription Drug Plan Details
Medicare Plan Name:WellCare Simple (PDP)
   by WellCare
State:Tennessee
Plan ID:S2505 - 001 - 0     Click to see other plans
Member Services:1-800-875-4068 TTY users 1-800-848-0298
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the WellCare Simple (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$27.10 (see Plan Premium Details below)
Annual Deductible:$360 (Tier excluded from the Deductible.)
$0 Premium if LIS Benefits?Yes, this plan does qualify for the $0 Premium. (See premiums for partial LIS subsidy below.)
Annual Initial Coverage Limit (ICL):$3,310
Drug Benefit Type ❔Actuarially Equivalent Standard (AE)
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:2,964 drugsBrowse the WellCare Simple (PDP) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. 
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$0.00$5.00$47.0050%25%
• Number of Drugs per
  Tier:		324416898800526
Plan's Pharmacy Search:https://www.wellcare.com/Find-a-Provider#/Search
Plan Offers Mail Order?Yes
Plan Type (Reach):National Plan
Number of Members enrolled in this plan in Tennessee:12,174 members
Number of Members enrolled in this plan in your CMS Region:24,651 members     (CMS Region 12)
Number of Members enrolled in this plan nationally:70,866 members
Plan’s Summary Star Rating: 3 out of 5 Stars.
• Customer Service Rating: 4 out of 5 Stars.
• Member Experience Rating: 3 out of 5 Stars.
• Drug Cost Accuracy Rating: 3 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows: ❔
Total
Premium		Part D Basic
Premium		Part D Supplemental
Premium
$27.10$27.10$0.00
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$0.00$6.80$13.50$20.30




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