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 didn’t know he had a bill to pay. After returning home in April, they received a letter from Wellcare terminating his coverage after three months of unpaid $28.80 premiums. Medicare rules now prevent him from enrolling in a new plan until the fall, locking him out of coverage until 2027.
Pare requires Xarelto, a costly blood thinner costing ~$1,800 per 90-day supply via GoodRx. Without it, Tix warns, he faces life-threatening risks from strokes or clots. He is one of tens of thousands of Wellcare Value Script enrollees facing coverage termination due to unpaid premiums.
Congress established Medicare drug coverage in 2003, administered by commercial insurers competing for 56 million beneficiaries. Zero-premium plans like Wellcare’s Value Script, with nearly 6 million members, gained popularity but faced unexpected 2026 premium hikes in 26 states and D.C.
Medicare drug plans can terminate coverage after a two-month grace period for unpaid premiums, regardless of amount. In Nevada, some owed as little as $8.10. Wellcare canceled coverage for ~140,000 Value Script members in April, with 40,000 potentially re-enrolling via low-income programs.
Agencies declined to disclose exact disenrollment numbers. Wellcare’s parent company, Centene, stated all members received change notices in September but acknowledged some may have missed them. Automated deductions from Social Security benefits often ceased when premiums shifted from zero to non-zero, creating payment gaps.
“Medicare should intervene to prevent this,” said Wayne Bennett, 74, who lost $3.60 monthly premiums. He requires nine medications and faces uncertainty about future costs after coverage ended in May.
Beneficiaries often assume zero-premium plans remain free indefinitely. Many arranged automatic Social Security deductions that stopped when premiums increased, requiring manual payment setups they overlooked. Wellcare sent notices via mail, calls, and texts, but confusion persists.
Centene’s Sarah Baiocchi stated members received required notices but emphasized the agency’s limitations in intervening. CMS rules restrict mid-year changes unless specific exceptions apply, such as low-income status or program participation.
Some exceptions allow immediate enrollment in five-star plans, but only two insurers offer these—primarily for retirees. Over 8,700 are enrolled as of June. Nonprofit SHIP counselors help navigate options, but many beneficiaries miss deadlines due to assumption of scams or lack of awareness.