Tens of thousands of Medicare beneficiaries enrolled in Wellcare’s "Value Script" prescription drug plan lost their coverage in 2026 after failing to pay monthly premiums that had recently increased. According to a KFF Health News analysis, many members were caught off guard by these new costs, leading to involuntary disenrollment after a grace period. Because Medicare rules typically prohibit midyear reenrollment, these individuals may remain without drug coverage until the next open enrollment period, risking potential late-enrollment penalties and significant out-of-pocket medication costs.
Why Medicare Beneficiaries Lost Coverage
The loss of coverage stems from a shift in premium structures for the popular "Value Script" plan, which previously offered $0 monthly premiums for many members. According to Centene Corp., Wellcare’s parent company, some members experienced a premium increase for the first time in several years.
While the Centers for Medicare & Medicaid Services (CMS) requires plans to provide an annual notice of changes each September, some beneficiaries were unaware of the new costs. This lack of awareness was exacerbated for members who previously had their premiums automatically deducted from Social Security checks. Because the plan was previously free, those automatic deductions ceased, and many members did not realize they needed to re-establish payment methods once premiums were introduced.
The Impact of Unpaid Premiums
Once a premium is missed, Medicare drug plans are required to provide a grace period—typically two months, though Wellcare extended this to three months—before terminating coverage for non-payment. According to a person with knowledge of the matter, Wellcare terminated coverage for approximately 140,000 beneficiaries in April.
The consequences for those dropped from their plans are severe:
- Coverage Gap: Beneficiaries cannot reenroll in a new plan until the next open enrollment period in the fall, with coverage beginning January 1, 2027.
- Financial Penalties: Those who go without prescription drug coverage for 63 days or more may face a permanent late-enrollment penalty that increases annually.
- Medication Costs: Without insurance, patients must pay full retail prices for essential medications, such as blood thinners or treatments for chronic conditions, unless they qualify for specific exemptions.
Navigating Enrollment Exceptions
Most beneficiaries who lose coverage for non-payment are locked out of the system for the remainder of the year. However, there are limited exceptions. According to CMS, individuals who qualify for "Extra Help"—a federal program that assists with Medicare prescription drug costs—may be able to reenroll immediately.
Other potential, though rare, pathways include:
- State Assistance Programs: Some states offer pharmacy assistance programs for specific conditions, such as HIV/AIDS, which may provide a pathway to reenrollment.
- Special Enrollment Periods: CMS allows midyear switches only under specific circumstances, such as moving out of a plan’s service area or experiencing a natural disaster.
How to Prevent Future Disenrollment
To avoid losing coverage due to premium changes, experts recommend that Medicare beneficiaries remain proactive during the annual enrollment period each fall.
- Review Annual Notices: Read the "Annual Notice of Changes" (ANOC) sent by your plan in September. It details any premium or coverage changes that will take effect on January 1.
- Verify Payment Methods: If your plan charges a premium, confirm that your payment method is active. If you previously relied on Social Security deductions, ensure the plan has your current billing information.
- Seek Free Assistance: The State Health Insurance Assistance Program (SHIP) provides free, unbiased counseling to help beneficiaries navigate plan changes and payment issues.
CMS and Centene have declined to provide a state-by-state breakdown of the disenrollment figures. With premium and benefit changes for 2027 scheduled to be released in September, beneficiaries are encouraged to review their plan documents to ensure they understand their financial obligations for the coming year.
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