When assisting beneficiaries and current members:

• Be sure to enroll each beneficiary into the plan that best meets their healthcare needs.
• Refrain from unsolicited suggestions to beneficiaries and current members regarding primary care physician changes based on provider-based agent financial incentive programs.
• Ask about current providers (both PCPs and specialists) and always verify provider’s availability using the Find a Provider tool to determine if they are in-network.
• Review each item on the required Pre-Enrollment Checklist in full with every beneficiary, and confirm beneficiary understanding of all items prior to enrollment. The checklist can be found in Wellcare’s Pre-Enrollment Guides(s), available in the Digital Resource Center.
• Review the Helpful Tips for Conducting a Successful Sales Appointment resource for additional reminders regarding conducting sales appointments.

Refer to the CMS marketing and enrollment guidance contained within the annual certification training you complete each year for a comprehensive reminder of acceptable and prohibited marketing practices. 

As always, we thank you for your continued partnership.

Starting in April, states will have the ability to resume the Medicaid Redetermination process after three years of being paused due to the COVID pandemic. States can begin to initiate the redetermination process as early as February 1, 2023, and disenrollments can be effective as early as April 1 if adequate notice is given to the enrollee. Each state will set the date for when redetermination will start. 

Approximately 15 million individuals will be at risk of losing Medicaid coverage. Anyone who is no longer eligible for Medicaid will be disenrolled. Wellcare members set to be disenrolled from their Medicaid plans will need your help to obtain new coverage and maintain continuity of coverage.

Be On the Lookout

Detailed communications will follow soon with state-specific information. Be sure to read these communications thoroughly and familiarize yourself with the processes and effected dates.

Be Prepared

• Refer to state-specific resources for dates and deadlines for Medicaid Redetermination.
• Assist members with upcoming redetermination changes.
• Remind current members:

• Expect calls from notified members who are no longer eligible for Medicaid and need alternative coverage options.
• Remember that prospective members will be subject to eligibility determination.

Let’s ensure our members don’t experience a gap in coverage.

• Wellcare D-SNP beneficiaries who no longer qualify for Medicaid will be disenrolled after the deeming period and will need other coverage options. Wellcare implements a six-month deeming period for D-SNP (Tennessee is the exception at three months).
• For individuals no longer eligible, brokers should discuss non-dual Medicare plan options. Those eligible for Medicare, they will have a 60-day window during which they can transition to Medicare without any late enrollment penalties.
• Secondarily, members losing Medicaid eligibility may explore Ambetter Health Marketplace plan options. The window to enroll in a marketplace plan will start 60 days before their Medicaid coverage ends and will continue for 60 days after it ends.
• Current members under Wellcare D-SNP will be supported by our Wellcare partner, Centauri, to help members reapply for Medicaid and the Medicare Savings Program. 

Stay Tuned

Additional information will be provided at the state level as each state confirms their Medicaid Redetermination process initiation date. A follow-up communication will be sent at that time which will provide additional resources to help you in assisting your clients.

As always, thank you for your continued partnership.