ᎭᏓᎾᏫᏓ ᎾᎢ ᏄᎬᏫᏳᏒ ᎦᎸᏛᎢ

Thank you for being a Wellcare Member!

Here you can quickly get to the documents and forms that are specific to your plan.

This plan is offered exclusively to enrollees with both Medicare and Medicaid eligibility. It provides coverage for all Medicare-covered Part A and Part B services received from network providers as well as prescription drugs. The plan may also cover supplemental, non-Medicare covered services such as routine dental, vision and hearing care.


ᏑᏕᏘᏴᏛ ᎠᏓᏃᎯᏎᎯ ᎥᎿᎢ ᎦᏁᏟᏴᏍᏗ (ANOC)

This document (the “Annual Notice of Change”) includes any changes in coverage, costs, or service area between plan years.



ᎯᎠ ᎪᏪᎳᏅᎢ ᏗᏠᏯᏍᏓ ᏂᎦᎥ ᏗᎦᏁᏟᏴᏓ ᎾᎿᎢ ᏣᏚᏓᎸᏛᎢ, ᏧᎬᏩᎶᏗ, ᎠᎴᏃ ᎢᏯᏓᏛᏁᏗ ᎢᎬᎾᏕᎾ ᎤᏜᏅᏛᎢ ᎠᏍᏓᏩᏛᏍᏗ ᎤᏕᏘᏴᏌᏗᏒᎢ.

ᎠᏍᏓᏩᏛᏍᏗ ᏗᏙᎳᎩ ᏗᎪᏪᎳᏅᎢ

ᎯᎠ ᎪᏪᎳᏅᎢ ᏗᎾᏓᏁᏢᏍᎩ ᎢᎦᏓ ᎾᏍᎩ ᏗᎦᏎᏍᏙᏗ ᎥᎿᎢ ᎯᎠ ᎠᏍᏓᏩᏛᏍᏗ. ᎾᏍᎩᎾ ᎧᎵᎢ ᏕᎦᏅᏛᎢ ᎥᎿᎢ ᏧᎾᎵᏍᏕᎸᏙᏗ, ᎠᎪᏩᏛᏗ ᏣᏤᎵ ᏗᎳᏏᏙᏗ ᎥᎿᎢ ᏣᏚᏓᎸᏛᎢ.

ᎯᎠ ᎪᏪᎳᏅᎯ ᏗᏲᏯᏍᏓ ᎾᏍᎩ ᏓᎳᏏᏛᎢ, ᏫᏚᏍᏗᎬ ᏄᏍᏛ ᏗᎧᏃᏗ ᎥᎿᎢ ᏣᏤᎵ ᏧᎾᎵᏍᏕᎸᏙᏗ ᎠᎴ ᏧᎬᏩᎶᏗ ᎾᏍᎩ ᎨᎵ.

This document provides additional details about the dental benefits, including a list of services and benefit limits.

Use this form to enroll in a Medicare Advantage Plan

ᏃᏈᏏ ᎢᎦᎢ ᏧᏂᏅᏅᎢ ᏰᎵ ᎣᏍᏓ Medicare ᏅᏩᏙᎯᏯᏛ ᎠᎴ ᎠᎩᏍᏗ ᎤᏴᏍᏗ ᏗᏍᏓᏩᏛᏍᏗ ᏂᎦᎵᏍᏗᏍᎬᎢ ᎾᎿᎢ ᏧᏓᎴᏅᏓ ᏗᎦᏟᏌᏅᎯ. Medicare ᎾᏍᎩᏛ ᎬᏗ ᎤᏂᏯᏙᏢᎢ. Medicare ᏗᏓᎪᎵᏰᏙᏗ ᎠᏍᏓᏩᏛᏍᏗ ᏓᎳᏏᏔᏅᎩ ᎤᎾᎢ 5-ᏃᏈᏏ ᎢᎦᎢ ᏧᏂᏅᏅᎢ ᏄᏍᏗᏓᏅᎢ. ᏃᏈᏏ ᎢᎦᎢ ᏧᏂᏅᏅᎢ ᎨᏒᎢ ᏗᏎᎯᏍᏔᏅ ᎾᏕᏘᏴᎯᏒᎢ ᎠᎴ ᏰᎵᏉ ᏯᏓᏁᏟᏴᎾ ᎾᏍᎩᎾ ᏑᏕᏘᏴᏓ ᏂᏕᎦᎵᏍᏔᏂᏒ ᎾᏃ ᏐᎢ.

ᏧᏠᏱ ᏧᏂᎪᎵᏰᏗ

New in 2023: Find A Provider Tool and Provider National Network Updates

Original Medicare Defined Cost Share Amounts and Premiums

Below is a list of preferred diabetes testing supplies (blood glucose meters and test strips) you can receive from an in-network pharmacy.

ᎯᎠ ᎬᏙᏗ ᎠᎧᎵᏏᏐᏗ ᎾᎢ ᎣᎦᎵᏍᎪᎸᏓᏁᎯ ᎾᎢ ᎠᏎᏒᏗ ᏣᏤᎵ ᏂᏅᏓ ᏂᎦᎵᏍᏔᏂᏒ ᏫᏓᏤᏢᎢ ᎾᏍᎩᎾ ᏣᏤᎵ ᎠᏕᎳᏗᏗᎢ.

Complete this form to request reimbursement for covered medical services that you paid for out of pocket.

Use this claim form to be reimbursed for eligible over-the-counter items. Please submit one form per member.

ᎯᎠ ᎪᏪᎳᏅᎢ ᏓᏠᏯᏍᏗ ᏄᏰᎵᏛ ᎢᎸᏍᎩ-ᎦᏬᏂᎯᏍᏗ ᎠᎾᏁᏢᏗᏍᎩ ᎢᏗᏓᏛᏁᏗ ᎾᏍᎩᎾ ᏗᏂᏫᏂᏍᎩ ᎥᎿᎢ ᎠᎴᏈᏯ, ᏓᎶᏂᎨᏍᏛᏱ ᎧᏂᏙᏁᏎ, ᏓᎶᏂᎨᏍᏛᏱ ᏍᎦᏓᏈᏂ, ᎠᎦᎸᏥ ᏈᎢᎣᎵ, ᎠᎦᎧᏥ, ᎠᏂᏓᏥ, ᎯᎿᏗ, ᎢᏔᎵᎠᏃ, ᏣᏩᏂᏏᎢ, ᎪᏫᏯᏂ, ᏉᎵᏏᎢ, ᏉᏣᎩᏍ, ᏲᏅᎯ, ᏍᏆᏂ, ᏔᎦᎠᏓ, ᎠᎴ ᏫᎡᏘᎾᎻᎢᏏ.

ᎯᎠ ᎠᎸᎵᎢᏍᏗ ᏕᎪᎯᏳᏗ ᏣᏤᎵ ᎠᏔᏲᏍᏗ ᎾᏍᎩᎾ ᏗᎪᏍᎩ ᎠᏂᏴᏫ ᎾᎢ ᎾᎸᏕᎲ ᎾᏍᎩ ᎡᎵᏍᏗ ᏣᏤᎵ ᏗᏣᎳᏫᏤᎲ ᎾᎿᎢ ᏗᎵᎪᏔᏅᎯ ᎬᏗ ᎾᏍᎩ ᎯᏔᏲᎯᎲ ᏣᏤᎵᎢ.

Each member requesting to be disenrolled must complete their own form.

Part D Late Enrollment Penalty (LEP) Reconsideration Request Form

ᎯᎠ ᎠᎧᎵᎢᏍᏗ ᏣᏤᎵ ᎠᏓᎵᏍᎪᎸᏓᏁᎯ ᎾᏍᎩᎾᎢ WellCare ᏰᎵᏉ ᏗᎪᏏᏐᏗ ᎠᎴᏃ ᎦᎾᏄᎪᏫᏍᏗ ᎠᏓᎦᏎᏍᏙᏗ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ (PHI) ᎬᏗ ᎾᏍᎩ ᏗᎪᏍᎩ ᎠᏂᏴᏫ.

ᎯᎠ ᎠᎧᎵᎢᏍᏗ ᏧᏩᏎᎯᏍᏗ ᏣᏤᎵ ᎠᏓᎵᏍᎪᎸᏓᏁᎯ ᎾᏍᎩᎾ WellCare ᎾᎢ ᏗᎪᏏᏐᏗ ᎠᎴᏃ ᎦᎾᏄᎪᏫᏍᏗ ᎠᏓᎦᏎᏍᏙᏗ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ (PHI) ᎬᏗ ᎾᏍᎩ ᏗᎪᏍᎩ ᎠᏂᏴᏫ.

Please complete this form with your provider if you want to change your PCP. Your provider will then send this form to your health plan, letting them know about the change.

ᎠᎵᏍᏕᎵᏍᎩ ᎧᏃᎮᏢᎥᏍᎩ

24-Hour Nurse Advice Line

One of the benefits of being a Wellcare member is our 24-Hour Nurse Advice Line. Our nurses will give you answers to your medical questions and help you decide whether to see your doctor or go to the emergency room. Nurses are available 24 hours a day, seven days a week at 1-800-581-9952. (TTY users dial 711.)

Surgery Assistance

If you or a loved one had to have surgery, would you know what to do first?
One question in many people's minds is, "Do I need surgery, or is there another option?"

Introducing Welvie® - an online surgery decision-support program that you can use with your doctor to decide on, prepare for and recover after surgery. And it is available at no extra cost to you.

You are six steps away from better results.
Welvie has broken down your surgery journey into six simple steps that take you from diagnosis to recovery:

Step 1 - Get the right diagnosis

Step 2 - Find the right doctor

Step 3 - Make a treatment decision

Step 4 - Learn about hospitals

Step 5 - Prepare for surgery

Step 6 - Recover at home

It pays to know Welvie.
For current Wellcare members only: After you complete the first three steps of the Welvie program, you will receive a $25 amazon.com gift card. Even if you are not considering surgery right now, be sure to check out Welvie so if you are faced with making a surgery decision in the future, you will be prepared.

Take me to Welvie

  • 24 Hour Nurse Advice Line

    24-Hour Nurse Advice Line

    One of the benefits of being a Wellcare member is our 24-Hour Nurse Advice Line. Our nurses will give you answers to your medical questions and help you decide whether to see your doctor or go to the emergency room. Nurses are available 24 hours a day, seven days a week at 1-800-581-9952. (TTY users dial 711.)
  • Surgery Decision Assistance

    Surgery Assistance

    If you or a loved one had to have surgery, would you know what to do first?
    One question in many people's minds is, "Do I need surgery, or is there another option?"

    Introducing Welvie® - an online surgery decision-support program that you can use with your doctor to decide on, prepare for and recover after surgery. And it is available at no extra cost to you.

    You are six steps away from better results.
    Welvie has broken down your surgery journey into six simple steps that take you from diagnosis to recovery:

    Step 1 - Get the right diagnosis

    Step 2 - Find the right doctor

    Step 3 - Make a treatment decision

    Step 4 - Learn about hospitals

    Step 5 - Prepare for surgery

    Step 6 - Recover at home

    It pays to know Welvie.
    For current Wellcare members only: After you complete the first three steps of the Welvie program, you will receive a $25 amazon.com gift card. Even if you are not considering surgery right now, be sure to check out Welvie so if you are faced with making a surgery decision in the future, you will be prepared.

    Take me to Welvie

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ᎤᏚᎸᏓ ᎠᏍᏕᎸᏗᎢ? ᎠᎭᏂ ᎣᏤᏙ ᏂᎯ ᏳᏰᎵᏗ.

ᎢᏍᎩᏟᏃᎮᏓ ᏂᎦᏓ
Y0020_WCM_100876E Last Updated On: 9/6/2022