Thousands of Medicare beneficiaries lost their drug coverage after their premiums increased, and they were unaware of this change.
Jude Pare and his partner, Diane Tix, live in rural Minnesota until temperatures dip below freezing, when they take refuge in Arizona for the winter. While away, their mail is forwarded. But Pare, 77, said he didn’t receive any warning from his Medicare prescription drug plan that his $0 monthly premium was about to increase.
So he did not know he was billed for payment. After he and Tix returned home to Minnesota in April, they received a letter from Wellcare, the insurer that provided his drug plan, stating that his coverage had been terminated after three months of unpaid premiums totalling $28.80. Under Medicare’s rules, he can’t enrol in a plan again until the fall, with coverage starting in 2027.
Pare takes Xarelto, a blood thinner that reduces his risk of strokes, blood clots, and pulmonary embolism. “He could bleed to death without it,” Tix said. A 90-day supply of the drug costs about $1,800 using a coupon from GoodRx, a discount drug website, she said.
Pare is among tens of thousands of Medicare beneficiaries on Wellcare’s Value Script drug plan who will likely go without prescription drug coverage for the rest of the year because they did not pay premiums for three months.
Next year, thousands more people in 32 states and Washington, D.C., who are enrolled in zero-premium drug plans from Wellcare and other insurance companies may find themselves in the same situation if their premiums go up and they don’t realise it, according to a KFF Health News analysis of drug plan data. In September, Wellcare will unveil the premiums and other changes for 2027.
Caught off guard
Going without medication can be life-threatening, especially for Medicare beneficiaries. Nearly 90% take one or more prescription drugs, according to the Centers for Disease Control and Prevention. Almost half live with four or more chronic health conditions that can cause functional or cognitive impairments.
By the time Jude Pare and his partner, Diane Tix, found out he owed $28.80 for three months of drug plan premiums, his coverage had been cancelled. He is among tens of thousands of Medicare beneficiaries who will likely go without prescription drug coverage for the rest of the year after their drug plans were cancelled.
Congress added prescription drug coverage to Medicare in 2003. But the coverage is administered by commercial insurance companies, which compete fiercely with one another for the business of about 56 million Medicare beneficiaries enrolled in drug plans.
Zero-dollar or very low monthly premiums have helped make Wellcare’s Value Script the bestselling stand-alone prescription drug plan in Medicare, with nearly 6 million customers across the U.S., according to government data. But in 26 states and Washington, D.C., some Value Script members who didn’t have to pay a premium last year were surprised by increases in 2026.
After a two-month grace period — which Wellcare extended to three — Medicare drug plans can drop customers who don’t pay their premiums, no matter how small the amount. Some members who lost their coverage in Nevada, for example, owed as little as $8.10 for three months, according to a KFF Health News analysis of Medicare drug plan data.
Wellcare terminated coverage for about 140,000 Value Script beneficiaries in April, according to a person with knowledge of the matter who was not authorised to speak publicly about it and feared reprisals at work for doing so. About 40,000 of the people who were dropped may be able to enrol in new coverage immediately because they have low incomes and receive financial assistance through a programme that Medicare calls “Extra Help.”
Multiple state officials said they had heard the same disenrollment figures, including Nevada’s insurance commissioner, Ned Gaines, who chairs the National Association of Insurance Commissioners’ senior issues task force; Rebecca Gouty, director of the State Health Insurance Assistance Program in West Virginia; and Tim Smolen, director of Washington State’s Statewide Health Insurance Benefits Advisors.
The West Virginia and Washington initiatives are part of the federally funded State Health Insurance Assistance Program (SHIP), which provides free, unbiased help navigating Medicare.
Surprise bills
The Centers for Medicare & Medicaid Services, which oversees Medicare drug plans, declined to provide the number of ValueScript members who lost coverage due to 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, said in a written statement to KFF Health News.
Centene Corp., WellCare’s parent company, also declined to provide disenrollment numbers.
“We recognise how disruptive a loss of coverage can be and are committed to helping members understand their options,” said Sarah Baiocchi, senior vice president for speciality 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 said all Value Script members received a CMS-required annual notice of changes in September, before the premium increases took effect.
A version of the booklet sent to members in two states and Washington, D.C., is 21 pages long. The new premium is mentioned on pages 3 and 8, along with changes to out-of-pocket costs and how to find updates on covered drugs and network pharmacies.
Wayne Bennett lost his Medicare drug coverage because he didn’t pay the premium, which was free last year but, without his knowing, went up this year. “Medicare should be doing something about this issue so that we can go ahead and get coverage now,” he says.
The company also informed members about 2026 premium changes through phone calls, text messages, regular mail, or email, Baiocchi said.
People who are dropped cannot re-enrol or join another drug plan until the start of the open enrolment period this fall for coverage beginning Jan. 1, unless they qualify for an exception, Krepich said.
And because they will have gone without coverage for at least 63 days, they could be hit with a permanent late-enrolment penalty that increases every year for the rest of their lives.
“Medicare should be doing something about the situation so that we can go ahead and get coverage now,” said Wayne Bennett, 74, who lives in Durham, North Carolina.
In May, he found out that Wellcare had cancelled his Value Script plan because he hadn’t paid his $3.60 monthly premiums. He takes nine prescription drugs to treat his blood pressure, glaucoma, chronic obstructive pulmonary disease, and other health problems. He filled most of his prescriptions, including several at no cost, before he lost coverage. He doesn’t know what he’ll have to pay when his supply runs out.
Gouty, the West Virginia programme head, said many Medicare beneficiaries arrange for their monthly drug plan premium to be automatically deducted from their Social Security benefits and that many likely thought that choice remained in place until they changed it.
“They didn’t realise that when the plan had a zero premium in 2025, it stopped the Social Security premium deduction and they would have had to reelect it for 2026,” Gouty said.
In other words, even if they mistakenly thought the premium was still zero, Medicare beneficiaries would have needed to somehow allow Social Security to make deductions — something the agency doesn’t do — or else set up a payment plan through their bank or credit card in case payment was necessary.
“That sounds goofy,” Tix said.
Centene’s Baiocchi blamed the Social Security Administration for the problem: “We believe this issue was a key driver of non-payment disenrollments and subsequent complaints.”
Spokespeople for the agency referred questions about the matter to CMS.
Krepich said that legal requirements for drug plan enrolment and disenrollment limit what CMS can do to help beneficiaries who lose coverage because they do not pay their premiums.
“Pretty upset”
Now that Pare has no prescription drug coverage, his doctor replaced his blood thinner medication with a much less expensive drug that should be just as effective. Pare paid $111 for four other medications that used to be free under his Value Script plan. He hasn’t had to refill four more prescriptions yet and doesn’t know what they will cost, Tix said.
If Wellcare members knew about the premium increases, they could have set up direct billing or an automatic payment plan early this year before the payment grace period ended April 1. But they could have filled prescriptions during the grace period, so if they missed Wellcare’s notices, they likely assumed their coverage was fine.
Bennett, the North Carolina man, said Wellcare used to send him text messages with health tips and reminders when it was time to pick up a prescription. He didn’t know his premium had increased from $0 to $3.60 until it was too late.
“I was pretty upset,” he said when he called the company. “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 service representative wouldn’t let him pay because his coverage had been cancelled, Bennett said.
Hoping to restore it, Bennett called Senior PharmAssist, a Durham nonprofit that advises Medicare beneficiaries and is one of more than 2,200 SHIP sites across the country. He was told he must wait until January to restart his drug coverage, said the group’s executive director, Gina Upchurch.
He doesn’t qualify for the “Extra Help” low-income subsidy or meet other CMS criteria for a special enrolment period, which would allow him to change drug plans during the year. CMS typically allows midyear switches for beneficiaries who, for example, move out of their plan’s service area, experience a natural disaster, or receive help paying for drugs through a state programme.
Senior PharmAssist was able to help one of its participants join another drug plan after she lost Value Script coverage because she is in North Carolina’s pharmacy assistance programme for people with HIV/AIDS and has limited income, Upchurch said.
A further exception allows any Medicare beneficiary to enrol at any time in a drug plan that has earned five stars, the top grade in Medicare’s performance ratings. However, there are no five-star Medicare drug plans available to the general public. Only two insurers offer five-star plans, and only for retirees from certain employers. Their combined enrolment is about 8,700 as of June 1, according to the insurers.
But Upchurch, with more than two decades of Medicare expertise, understands why beneficiaries might not pay attention or assume Wellcare’s messages were bogus. Older adults are particularly vulnerable to identity theft and other scams and are often advised to ignore junk mail and calls from telemarketers.
Since Value Script members such as Bennett continued to get their prescriptions filled during the payment grace period, “Why wouldn’t they think the process was a scam?” Upchurch asked. “They are constantly bombarded by people selling them something that’s illegitimate or trying to scam them.”
