Jude Pare and his companion, Diane Tix, dwell in rural Minnesota till temperatures dip beneath freezing, after they take refuge in Arizona for the winter. Whereas away, their mail is forwarded. However Pare, 77, stated he didn’t obtain any warning from his Medicare prescription drug plan that his $0 month-to-month premium was about to extend.
So he didn’t know he had a invoice to pay. After he and Tix returned residence to Minnesota in April, they received a letter from Wellcare, the insurer that supplied his drug plan, saying his protection had been terminated after three months of unpaid premiums totaling $28.80. Beneath Medicare’s guidelines, he can’t enroll in a plan once more till the autumn, for protection starting in 2027.
Pare takes Xarelto, a blood thinner that reduces his threat of strokes, blood clots, and pulmonary embolism. “He could bleed to death without it,” Tix stated. A 90-day provide of the drug prices about $1,800 utilizing a coupon from GoodRx, a reduction drug web site, she stated.
Pare is amongst tens of hundreds of Medicare beneficiaries who have been on Wellcare’s Worth Script drug plan who will possible go with out prescription drug protection for the remainder of the 12 months as a result of they didn’t pay premiums for 3 months.
Subsequent 12 months, hundreds extra individuals in 32 states and Washington, D.C., who’re enrolled in zero-premium drug plans from Wellcare and different insurance coverage firms might discover themselves in the identical scenario if their premiums go up and so they don’t notice it, in accordance with a KFF Well being Information evaluation of drug plan knowledge. Premiums and different modifications for 2027 can be unveiled in September.
Going with out treatment might be life-threatening, particularly for Medicare beneficiaries. Almost 90% take a number of pharmaceuticals, in accordance with the Facilities for Illness Management and Prevention. Virtually half dwell with 4 or extra power well being circumstances that may trigger practical or cognitive impairments.
Congress added prescription drug protection to Medicare in 2003. However the protection is run by industrial insurance coverage firms, which compete fiercely with each other for the enterprise of about 56 million Medicare beneficiaries enrolled in drug plans.
Zero-dollar or very low month-to-month premiums have helped make Wellcare’s Worth Script the bestselling stand-alone prescription drug plan in Medicare, with practically 6 million clients throughout the U.S., in accordance with authorities knowledge. However in 26 states and Washington, D.C., some Worth Script members who didn’t must pay a premium final 12 months have been caught off guard by will increase in 2026.
After a two-month grace interval — which Wellcare prolonged to a few — Medicare drug plans can drop clients who don’t pay their premiums, irrespective of how small the quantity. Some members who misplaced their protection in Nevada, for instance, owed as little as $8.10 for 3 months, in accordance with a KFF Well being Information evaluation of Medicare drug plan knowledge.
Wellcare terminated protection for about 140,000 Worth Script beneficiaries in April, in accordance with an individual with data of the matter who was not approved to talk publicly about it and feared reprisals at work for doing so. About 40,000 of the individuals who have been dropped might be able to enroll in new protection instantly as a result of they’ve low incomes and obtain monetary help by a program Medicare calls “Extra Help.”
A number of state officers stated they’d heard the identical disenrollment figures, together with Nevada’s insurance coverage commissioner, Ned Gaines, who chairs the Nationwide Affiliation of Insurance coverage Commissioners’ senior points process power; Rebecca Gouty, director of the State Well being Insurance coverage Help Program in West Virginia; and Tim Smolen, director of Washington state’s Statewide Well being Insurance coverage Advantages Advisors. The West Virginia and Washington initiatives are a part of the federally funded State Well being Insurance coverage Help Program, or SHIP, which gives free, unbiased assist navigating Medicare.
Shock Payments
The Facilities for Medicare & Medicaid Providers, which oversees Medicare drug plans, declined to offer the variety of Worth Script members who misplaced protection as a result of unpaid premiums. “The agency does not publicly provide plan-specific disenrollment figures or state-level breakdowns related to the non-payment of premiums,” Christopher Krepich, a spokesperson, stated in a written assertion to KFF Well being Information.
Centene Corp., Wellcare’s guardian firm, additionally declined to offer disenrollment numbers.
“We recognize how disruptive a loss of coverage can be and are committed to helping members understand their options,” stated Sarah Baiocchi, senior vp for specialty and prescription drug plans at Centene. She acknowledged that “some members in our Value Script plan experienced a premium for the first time, or for the first time in several years.”
Baiocchi stated all Worth Script members acquired a CMS-required annual discover of modifications in September, earlier than the premium will increase took impact.
A model of the booklet despatched to members in two states and Washington, D.C., is 21 pages lengthy. The brand new premium is talked about on pages 3 and eight, together with modifications to out-of-pocket prices and how you can discover updates on lined medicine and community pharmacies.
The corporate additionally knowledgeable members about 2026 premium modifications by cellphone calls, textual content messages, common mail, or e-mail, Baiocchi stated.
People who find themselves dropped are usually not capable of reenroll or be a part of one other drug plan till the beginning of the open enrollment interval this fall for protection starting Jan. 1, until they qualify for an exception, Krepich stated. And since they may have gone with out protection for at the very least 63 days, they might be hit with a everlasting late-enrollment penalty that will increase yearly for the remainder of their lives.
“Medicare should be doing something about this so that we can go ahead and get coverage now,” stated Wayne Bennett, 74, who lives in Durham, North Carolina.
In Might, he discovered that Wellcare had canceled his Worth Script plan as a result of he hadn’t paid his $3.60 month-to-month premiums. He takes 9 pharmaceuticals to deal with his blood strain, glaucoma, power obstructive pulmonary illness, and different well being issues. He crammed most of his prescriptions — together with a number of without charge — earlier than he misplaced protection. He doesn’t know what he’ll must pay when his provide runs out.
Gouty, the West Virginia program head, stated many Medicare beneficiaries organize for his or her month-to-month drug plan premium to be robotically deducted from their Social Safety advantages, and that many possible thought that selection remained in place till they modified it.
“They didn’t realize that when the plan was a zero premium in 2025, that stopped the Social Security premium deduction and they would have had to reelect it for 2026,” Gouty stated.
In different phrases, even when they mistakenly thought the premium was nonetheless zero, Medicare beneficiaries would have wanted to one way or the other enable Social Safety to make deductions — one thing the company doesn’t do — or arrange a cost plan by their financial institution or bank card in case cost was needed.
“That sounds goofy,” Tix stated.
Centene’s Baiocchi blamed the Social Safety Administration for the issue: “We believe this was a key driver of non-payment disenrollments and subsequent complaints.”
Spokespeople for the company referred questions in regards to the matter to CMS.
Krepich stated authorized necessities for drug plan enrollment and disenrollment restrict what CMS can do to assist beneficiaries who lose protection for not paying their premiums.
‘Pretty Upset’
Now that Pare has no prescription drug protection, his physician changed his blood thinner treatment with a a lot cheaper drug that must be simply as efficient. Pare paid $111 for 4 different drugs that was once free underneath his Worth Script plan. He hasn’t needed to refill 4 extra prescriptions but and doesn’t know what they may value, Tix stated.
If Wellcare members knew in regards to the premium will increase, they might have arrange direct billing or an computerized cost plan early this 12 months earlier than the cost grace interval ended April 1. However they’d have been capable of fill prescriptions through the grace interval, so in the event that they didn’t see Wellcare’s notices, they possible assumed there was no drawback with their protection.
Bennett, the North Carolina man, stated Wellcare used to ship him textual content messages with well being suggestions and reminders when it was time to choose up a prescription. He didn’t know his premium had elevated from $0 to $3.60 till it was too late.
“I was pretty upset,” he stated, when he referred to as the corporate. “The premium wasn’t that much, and I was ready to pay it right off the bat. I had my credit card out ready to make the payment.”
The customer support consultant wouldn’t let him pay as a result of his protection had been canceled, Bennett stated.
Hoping to revive it, Bennett referred to as Senior PharmAssist, a Durham nonprofit that advises Medicare beneficiaries and is one in all greater than 2,200 SHIP websites throughout the nation. He was advised he should wait till January to restart his drug protection, stated the group’s government director, Gina Upchurch.
He doesn’t qualify for the “Extra Help” low-income subsidy or meet different CMS standards for a particular enrollment interval, which might enable him to vary drug plans through the 12 months. CMS usually permits midyear switches for beneficiaries who, for instance, transfer out of their plan’s service space, expertise a pure catastrophe, or get assist paying for medicine from a state program.
Senior PharmAssist was capable of assist one in all its individuals be a part of one other drug plan after she misplaced Worth Script protection as a result of she is in North Carolina’s pharmacy help program for individuals with HIV/AIDS and has restricted revenue, Upchurch stated.
An extra exception permits any Medicare beneficiary to enroll at any time in a drug plan that has earned 5 stars, the highest grade in Medicare’s efficiency scores. Nevertheless, there aren’t any five-star Medicare drug plans obtainable to most people. Solely two insurers provide five-star plans, and just for retirees from sure employers. Their mixed enrollment is about 8,700 as of June 1, in accordance with the insurers.
However Upchurch, with greater than 20 years of Medicare experience, doesn’t blame beneficiaries for not paying consideration or for assuming Wellcare’s messages have been bogus. Older adults are notably susceptible to id theft and different scams and are sometimes suggested to disregard spam and calls from telemarketers.
Since Worth Script members reminiscent of Bennett continued to get their prescriptions crammed through the cost grace interval, “why wouldn’t they think this was a scam?” Upchurch requested. “They are constantly bombarded by people selling them something that’s illegitimate or trying to scam them.”
