Wellcare: Important Update on Eligibility Change for Tennessee Wellcare Dual Access (HMO D-SNP) H1416-035

In accordance with a new requirement by the State of Tennessee Medicaid Program (TennCare), Wellcare would like to inform you of a mid-year change in the eligibility criteria for the Tennessee Wellcare Dual Access (HMO D-SNP) H1416-035 plan.

  • Effective August 1, 2022 and moving forward, only beneficiaries with Medicare Savings Program (MSP) Levels of Qualified Medicare Beneficiary Only (QMB-only) will be allowed to enroll for Plan Year 2022. This means that any application for August 1, 2022 where the enrollee has an MSP level of FDBE, QMB+ and SLMB+ will be denied as ineligible. Only enrollees with QMB-only levels will be approved moving forward, including during the 2023 AEP season.
  • Members with effective dates prior to August 1, 2022, will continue to be covered at their current MSP level, including FDBE, QMB+ and SLMB+. As these members were enrolled prior to August 1, there is no action required from you. The member will continue to enjoy their benefits as long as their MSP level does not change.
  • After August 1, 2022, any member in the plan whose eligibility level changes to any MSP level other than QMB only will be disenrolled from the plan and be placed on Original Medicare. These members may exercise their special elections to enroll into an alternate Medicare Advantage plan.

What you should do:

  • Please ensure prior to enrolling future members in the Tennessee Wellcare Dual Access (HMO D-SNP) H14163-035 plan that the MSP level has been confirmed as QMB-only. Applications for MSP levels other than QMB-only in this plan will result in a denial. There is no change to eligibility criteria in other Wellcare plans in the state.  
  • Disregard the current Summary of Benefits (SB) and Evidence of Coverage (EOC) for this plan, as these are being updated to include the new eligibility criteria. Please destroy any current printed copies of the SB and EOC for this plan.
  • We will inform you when the updated SB and EOC are available and ready for use.

Please Note:

  • If an existing member’s MSP level changes, to other than QMB-only after July 1, 2022, the member will be disenrolled from this plan to go back to Original Medicare and Medicaid. They will need to be enrolled into a different plan.   

If you have any questions, call us today at 866-568-9649!


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