Jude Pare and his companion, Diane Tix, reside in rural Minnesota till temperatures dip under freezing, once they take refuge in Arizona for the winter. Whereas away, their mail is forwarded. However Pare, 77, mentioned 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 acquired 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. Underneath 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 might bleed to demise with out it,” Tix mentioned. A 90-day provide of the drug prices about $1,800 utilizing a coupon from GoodRx, a reduction drug web site, she mentioned.
Pare is amongst tens of 1000’s of Medicare beneficiaries who had 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, 1000’s extra individuals in 32 states and Washington, D.C., who’re enrolled in zero-premium drug plans from Wellcare and different insurance coverage corporations might discover themselves in the identical state of affairs if their premiums go up and so they don’t understand it, in keeping with a KFF Well being Information evaluation of drug plan knowledge. Premiums and different adjustments for 2027 can be unveiled in September.
Going with out remedy could be life-threatening, particularly for Medicare beneficiaries. Practically 90% take a number of pharmaceuticals, in keeping with the Facilities for Illness Management and Prevention. Virtually half reside with 4 or extra continual well being situations that may trigger useful or cognitive impairments.
Congress added prescription drug protection to Medicare in 2003. However the protection is run by business insurance coverage corporations, 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 almost 6 million prospects throughout the U.S., in keeping 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 had 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 prospects 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 keeping 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 keeping 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 had been dropped might be able to enroll in new protection instantly as a result of they’ve low incomes and obtain monetary help by way of a program Medicare calls “Further Assist.”
A number of state officers mentioned 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 pressure; 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 supplies free, unbiased assist navigating Medicare.
Shock Payments
The Facilities for Medicare & Medicaid Companies, which oversees Medicare drug plans, declined to supply the variety of Worth Script members who misplaced protection on account of unpaid premiums. “The company doesn’t publicly present plan-specific disenrollment figures or state-level breakdowns associated to the non-payment of premiums,” Christopher Krepich, a spokesperson, mentioned in a written assertion to KFF Well being Information.
Centene Corp., Wellcare’s guardian firm, additionally declined to supply disenrollment numbers.
“We acknowledge how disruptive a lack of protection could be and are dedicated to serving to members perceive their choices,” mentioned Sarah Baiocchi, senior vice chairman for specialty and prescription drug plans at Centene. She acknowledged that “some members in our Worth Script plan skilled a premium for the primary time, or for the primary time in a number of years.”
Baiocchi mentioned all Worth Script members acquired a CMS-required annual discover of adjustments 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 adjustments to out-of-pocket prices and the best way to discover updates on lined medicine and community pharmacies.
The corporate additionally knowledgeable members about 2026 premium adjustments by way of telephone calls, textual content messages, common mail, or e mail, Baiocchi mentioned.
People who find themselves dropped should 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 mentioned. And since they may have gone with out protection for no less than 63 days, they may very well be hit with a everlasting late-enrollment penalty that will increase yearly for the remainder of their lives.
“Medicare ought to be doing one thing about this in order that we will go forward and get protection now,” mentioned Wayne Bennett, 74, who lives in Durham, North Carolina.
In Could, he came upon 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 stress, glaucoma, continual obstructive pulmonary illness, and different well being issues. He crammed most of his prescriptions — together with a number of for gratis — 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, mentioned many Medicare beneficiaries organize for his or her month-to-month drug plan premium to be routinely deducted from their Social Safety advantages, and that many possible thought that selection remained in place till they modified it.
“They didn’t understand that when the plan was a zero premium in 2025, that stopped the Social Safety premium deduction and they might have needed to reelect it for 2026,” Gouty mentioned.
In different phrases, even when they mistakenly thought the premium was nonetheless zero, Medicare beneficiaries would have wanted to in some way enable Social Safety to make deductions — one thing the company doesn’t do — or arrange a fee plan by way of their financial institution or bank card in case fee was mandatory.
“That sounds goofy,” Tix mentioned.
Centene’s Baiocchi blamed the Social Safety Administration for the issue: “We consider 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 mentioned authorized necessities for drug plan enrollment and disenrollment restrict what CMS can do to assist beneficiaries who lose protection for not paying their premiums.
‘Fairly Upset’
Now that Pare has no prescription drug protection, his physician changed his blood thinner remedy with a a lot cheaper drug that ought to be simply as efficient. Pare paid $111 for 4 different medicines that was free underneath his Worth Script plan. He hasn’t needed to refill 4 extra prescriptions but and doesn’t know what they may price, Tix mentioned.
If Wellcare members knew in regards to the premium will increase, they may have arrange direct billing or an computerized fee plan early this 12 months earlier than the fee grace interval ended April 1. However they’d have been capable of fill prescriptions in the course of the grace interval, so in the event that they didn’t see Wellcare’s notices, they possible assumed there was no downside with their protection.
Bennett, the North Carolina man, mentioned 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 used to be fairly upset,” he mentioned, when he referred to as the corporate. “The premium wasn’t that a lot, and I used to be able to pay it proper off the bat. I had my bank card out able to make the fee.”
The customer support consultant wouldn’t let him pay as a result of his protection had been canceled, Bennett mentioned.
Hoping to revive it, Bennett referred to as Senior PharmAssist, a Durham nonprofit that advises Medicare beneficiaries and is considered one of greater than 2,200 SHIP websites throughout the nation. He was informed he should wait till January to restart his drug protection, mentioned the group’s government director, Gina Upchurch.
He doesn’t qualify for the “Further Assist” low-income subsidy or meet different CMS standards for a particular enrollment interval, which might enable him to alter drug plans in the course of the 12 months. CMS sometimes 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 considered one of its contributors 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 mentioned.
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 rankings. Nonetheless, there aren’t any five-star Medicare drug plans accessible to most people. Solely two insurers supply five-star plans, and just for retirees from sure employers. Their mixed enrollment is about 8,700 as of June 1, in keeping with the insurers.
However Upchurch, with greater than twenty years of Medicare experience, doesn’t blame beneficiaries for not paying consideration or for assuming Wellcare’s messages had been bogus. Older adults are significantly weak to identification theft and different scams and are sometimes suggested to disregard spam and calls from telemarketers.
Since Worth Script members resembling Bennett continued to get their prescriptions crammed in the course of the fee grace interval, “why wouldn’t they assume this was a rip-off?” Upchurch requested. “They’re always bombarded by individuals promoting them one thing that’s illegitimate or making an attempt to rip-off them.”
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