Thousands of Medicare Beneficiaries Misled About Free Drug Plans: What Happened Next
July 09, 2026
KFF Health News: Thousands of Medicare Beneficiaries Thought Their Drug Plan Was Free. Then They Lost It.
Jude Pare and his partner, Diane Tix, reside in rural Minnesota, migrating to Arizona for the winter months when temperatures plunge. During their time away, their mail is forwarded. However, 77-year-old Pare was unaware that his Medicare prescription drug plan, which had a $0 monthly premium, was about to increase. Consequently, he missed a crucial bill notification.
Upon returning to Minnesota in April, they received a letter from Wellcare, the insurer for his drug plan, stating that his coverage had been terminated due to three months of unpaid premiums totaling $28.80. According to Medicare regulations, he cannot re-enroll in a plan until the fall, with coverage commencing in 2027.
Pare relies on Xarelto, a blood thinner essential for reducing his risk of strokes, blood clots, and pulmonary embolism. “He could bleed to death without it,” Tix emphasized. A 90-day supply of this medication costs approximately $1,800, even with a GoodRx coupon.
Pare is one of tens of thousands of Medicare beneficiaries enrolled in Wellcare’s Value Script drug plan who may be left without prescription drug coverage for the remainder of the year due to unpaid premiums.
Next year, many more individuals across 32 states and Washington, D.C., enrolled in zero-premium drug plans from Wellcare and other insurers may face similar challenges if they are unaware of premium increases, as highlighted by a KFF Health News analysis. Details regarding premiums and other changes for 2027 will be revealed in September.
Going without necessary medications can pose severe health risks, particularly for Medicare beneficiaries. According to the Centers for Disease Control and Prevention, nearly 90% of these individuals take at least one prescription drug, and almost half manage four or more chronic health conditions that can lead to functional or cognitive impairments.
Prescription drug coverage was added to Medicare in 2003, but it is administered by commercial insurance companies competing for the business of approximately 56 million Medicare beneficiaries enrolled in drug plans.
Zero or very low monthly premiums have made Wellcare’s Value Script the most popular stand-alone prescription drug plan in Medicare, boasting nearly 6 million customers nationwide. However, in 26 states and Washington, D.C., some Value Script members who enjoyed a zero premium last year were caught off guard by increases in 2026.
After a grace period of two months—extended to three by Wellcare—Medicare drug plans can terminate coverage for non-payment of premiums, regardless of the amount owed. For instance, some members in Nevada lost their coverage after failing to pay as little as $8.10 over three months, according to KFF Health News analysis.
Wellcare terminated coverage for approximately 140,000 Value Script beneficiaries in April, as reported by a source who wished to remain anonymous. About 40,000 of those affected may qualify for immediate enrollment in new coverage due to low income and financial assistance through Medicare’s “Extra Help” program.
State officials, including Nevada’s insurance commissioner, Ned Gaines, and others from West Virginia and Washington, have corroborated these disenrollment figures. These states are part of the federally funded State Health Insurance Assistance Program (SHIP), which offers free, unbiased assistance in navigating Medicare.
Surprise Bills
The Centers for Medicare & Medicaid Services (CMS), which oversees Medicare drug plans, did not disclose the number of Value Script 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,” stated spokesperson Christopher Krepich.
Centene Corp., Wellcare’s parent company, also refrained from sharing disenrollment statistics. “We recognize how disruptive a loss of coverage can be and are committed to helping members understand their options,” said Sarah Baiocchi, senior vice president for specialty 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 noted that all Value Script members received a CMS-required annual notice of changes in September, prior to the premium increases taking effect. A version of the booklet sent to members is 21 pages long, detailing the new premium on pages 3 and 8, along with changes to out-of-pocket costs and how to find updates on covered drugs and network pharmacies.
Members were also informed about the 2026 premium changes through phone calls, text messages, regular mail, or email, according to Baiocchi.
Individuals who lose coverage cannot re-enroll or join another drug plan until the open enrollment period this fall, unless they qualify for an exception. If they have gone without coverage for at least 63 days, they may incur a permanent late-enrollment penalty that increases annually for the rest of their lives.
“Medicare should be doing something about this so that we can go ahead and get coverage now,” expressed Wayne Bennett, 74, from Durham, North Carolina. In May, he discovered that Wellcare had canceled his Value Script plan due to unpaid premiums of $3.60. He takes nine prescription drugs for various health issues and is uncertain about the costs when his current supply runs out.
Gouty, the West Virginia program director, noted that many Medicare beneficiaries set up automatic deductions for their monthly drug plan premiums from Social Security benefits, often assuming this arrangement remains unchanged. “They didn’t realize that when the plan was a zero premium in 2025, that stopped the Social Security premium deduction,” she explained.
“That sounds goofy,” Tix remarked.
Baiocchi attributed the issue to the Social Security Administration, stating, “We believe this was a key driver of non-payment disenrollments and subsequent complaints.” Agency representatives directed inquiries back to CMS.
Krepich indicated that legal requirements for drug plan enrollment and disenrollment restrict CMS’s ability to assist beneficiaries who lose coverage due to unpaid premiums.
‘Pretty Upset’
With no prescription drug coverage, Pare’s doctor switched his blood thinner to a more affordable alternative. Pare paid $111 for four other medications that were previously free under his Value Script plan. He remains uncertain about the costs of four additional prescriptions he has yet to refill.
If Wellcare members had been aware of the premium increases, they could have arranged direct billing or an automatic payment plan before the grace period ended on April 1. However, since they could still fill prescriptions during the grace period, many likely assumed their coverage was secure.
Bennett, the North Carolina resident, mentioned that Wellcare used to send him text reminders for prescription pickups. He only learned about the premium increase from $0 to $3.60 when it was too late.
“I was pretty upset,” he recounted, recalling his call to 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.” Unfortunately, the customer service representative informed him that he could not pay because his coverage had already been canceled.
In hopes of reinstating his coverage, Bennett reached out to Senior PharmAssist, a nonprofit in Durham that advises Medicare beneficiaries. He was informed that he must wait until January to restart his drug coverage, according to Gina Upchurch, the group’s executive director.
Bennett does not qualify for the “Extra Help” low-income subsidy or meet other CMS criteria for a special enrollment period, which would allow him to change drug plans mid-year. CMS typically permits such changes for beneficiaries who experience specific circumstances, such as moving out of their plan’s service area or receiving assistance from a state program.
Senior PharmAssist successfully assisted another participant in joining a different drug plan after losing Value Script coverage due to her limited income and enrollment in North Carolina’s pharmacy assistance program for individuals with HIV/AIDS.
While any Medicare beneficiary can enroll at any time in a five-star rated drug plan, there are currently no five-star Medicare drug plans available to the general public. Only two insurers offer five-star plans, and only for retirees from specific employers, with a combined enrollment of about 8,700 as of June 1.
Upchurch, with over two decades of Medicare experience, empathizes with beneficiaries who may overlook important details or assume Wellcare’s communications are scams. “Older adults are particularly vulnerable to identity theft and other scams and are often advised to ignore junk mail and calls from telemarketers,” she noted.
Given that Value Script members like Bennett continued to fill prescriptions during the payment grace period, “why wouldn’t they think this was a scam?” Upchurch questioned. “They are constantly bombarded by people selling them something illegitimate or trying to scam them.”
By Susan Jaffe
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
July 09, 2026
KFF Health News: Thousands of Medicare Beneficiaries Thought Their Drug Plan Was Free. Then They Lost It.
Jude Pare and his partner, Diane Tix, reside in rural Minnesota, migrating to Arizona for the winter months when temperatures plunge. During their time away, their mail is forwarded. However, 77-year-old Pare was unaware that his Medicare prescription drug plan, which had a $0 monthly premium, was about to increase. Consequently, he missed a crucial bill notification.
Upon returning to Minnesota in April, they received a letter from Wellcare, the insurer for his drug plan, stating that his coverage had been terminated due to three months of unpaid premiums totaling $28.80. According to Medicare regulations, he cannot re-enroll in a plan until the fall, with coverage commencing in 2027.
Pare relies on Xarelto, a blood thinner essential for reducing his risk of strokes, blood clots, and pulmonary embolism. “He could bleed to death without it,” Tix emphasized. A 90-day supply of this medication costs approximately $1,800, even with a GoodRx coupon.
Pare is one of tens of thousands of Medicare beneficiaries enrolled in Wellcare’s Value Script drug plan who may be left without prescription drug coverage for the remainder of the year due to unpaid premiums.
Next year, many more individuals across 32 states and Washington, D.C., enrolled in zero-premium drug plans from Wellcare and other insurers may face similar challenges if they are unaware of premium increases, as highlighted by a KFF Health News analysis. Details regarding premiums and other changes for 2027 will be revealed in September.
Going without necessary medications can pose severe health risks, particularly for Medicare beneficiaries. According to the Centers for Disease Control and Prevention, nearly 90% of these individuals take at least one prescription drug, and almost half manage four or more chronic health conditions that can lead to functional or cognitive impairments.
Prescription drug coverage was added to Medicare in 2003, but it is administered by commercial insurance companies competing for the business of approximately 56 million Medicare beneficiaries enrolled in drug plans.
Zero or very low monthly premiums have made Wellcare’s Value Script the most popular stand-alone prescription drug plan in Medicare, boasting nearly 6 million customers nationwide. However, in 26 states and Washington, D.C., some Value Script members who enjoyed a zero premium last year were caught off guard by increases in 2026.
After a grace period of two months—extended to three by Wellcare—Medicare drug plans can terminate coverage for non-payment of premiums, regardless of the amount owed. For instance, some members in Nevada lost their coverage after failing to pay as little as $8.10 over three months, according to KFF Health News analysis.
Wellcare terminated coverage for approximately 140,000 Value Script beneficiaries in April, as reported by a source who wished to remain anonymous. About 40,000 of those affected may qualify for immediate enrollment in new coverage due to low income and financial assistance through Medicare’s “Extra Help” program.
State officials, including Nevada’s insurance commissioner, Ned Gaines, and others from West Virginia and Washington, have corroborated these disenrollment figures. These states are part of the federally funded State Health Insurance Assistance Program (SHIP), which offers free, unbiased assistance in navigating Medicare.
Surprise Bills
The Centers for Medicare & Medicaid Services (CMS), which oversees Medicare drug plans, did not disclose the number of Value Script 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,” stated spokesperson Christopher Krepich.
Centene Corp., Wellcare’s parent company, also refrained from sharing disenrollment statistics. “We recognize how disruptive a loss of coverage can be and are committed to helping members understand their options,” said Sarah Baiocchi, senior vice president for specialty 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 noted that all Value Script members received a CMS-required annual notice of changes in September, prior to the premium increases taking effect. A version of the booklet sent to members is 21 pages long, detailing the new premium on pages 3 and 8, along with changes to out-of-pocket costs and how to find updates on covered drugs and network pharmacies.
Members were also informed about the 2026 premium changes through phone calls, text messages, regular mail, or email, according to Baiocchi.
Individuals who lose coverage cannot re-enroll or join another drug plan until the open enrollment period this fall, unless they qualify for an exception. If they have gone without coverage for at least 63 days, they may incur a permanent late-enrollment penalty that increases annually for the rest of their lives.
“Medicare should be doing something about this so that we can go ahead and get coverage now,” expressed Wayne Bennett, 74, from Durham, North Carolina. In May, he discovered that Wellcare had canceled his Value Script plan due to unpaid premiums of $3.60. He takes nine prescription drugs for various health issues and is uncertain about the costs when his current supply runs out.
Gouty, the West Virginia program director, noted that many Medicare beneficiaries set up automatic deductions for their monthly drug plan premiums from Social Security benefits, often assuming this arrangement remains unchanged. “They didn’t realize that when the plan was a zero premium in 2025, that stopped the Social Security premium deduction,” she explained.
“That sounds goofy,” Tix remarked.
Baiocchi attributed the issue to the Social Security Administration, stating, “We believe this was a key driver of non-payment disenrollments and subsequent complaints.” Agency representatives directed inquiries back to CMS.
Krepich indicated that legal requirements for drug plan enrollment and disenrollment restrict CMS’s ability to assist beneficiaries who lose coverage due to unpaid premiums.
‘Pretty Upset’
With no prescription drug coverage, Pare’s doctor switched his blood thinner to a more affordable alternative. Pare paid $111 for four other medications that were previously free under his Value Script plan. He remains uncertain about the costs of four additional prescriptions he has yet to refill.
If Wellcare members had been aware of the premium increases, they could have arranged direct billing or an automatic payment plan before the grace period ended on April 1. However, since they could still fill prescriptions during the grace period, many likely assumed their coverage was secure.
Bennett, the North Carolina resident, mentioned that Wellcare used to send him text reminders for prescription pickups. He only learned about the premium increase from $0 to $3.60 when it was too late.
“I was pretty upset,” he recounted, recalling his call to 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.” Unfortunately, the customer service representative informed him that he could not pay because his coverage had already been canceled.
In hopes of reinstating his coverage, Bennett reached out to Senior PharmAssist, a nonprofit in Durham that advises Medicare beneficiaries. He was informed that he must wait until January to restart his drug coverage, according to Gina Upchurch, the group’s executive director.
Bennett does not qualify for the “Extra Help” low-income subsidy or meet other CMS criteria for a special enrollment period, which would allow him to change drug plans mid-year. CMS typically permits such changes for beneficiaries who experience specific circumstances, such as moving out of their plan’s service area or receiving assistance from a state program.
Senior PharmAssist successfully assisted another participant in joining a different drug plan after losing Value Script coverage due to her limited income and enrollment in North Carolina’s pharmacy assistance program for individuals with HIV/AIDS.
While any Medicare beneficiary can enroll at any time in a five-star rated drug plan, there are currently no five-star Medicare drug plans available to the general public. Only two insurers offer five-star plans, and only for retirees from specific employers, with a combined enrollment of about 8,700 as of June 1.
Upchurch, with over two decades of Medicare experience, empathizes with beneficiaries who may overlook important details or assume Wellcare’s communications are scams. “Older adults are particularly vulnerable to identity theft and other scams and are often advised to ignore junk mail and calls from telemarketers,” she noted.
Given that Value Script members like Bennett continued to fill prescriptions during the payment grace period, “why wouldn’t they think this was a scam?” Upchurch questioned. “They are constantly bombarded by people selling them something illegitimate or trying to scam them.”
By Susan Jaffe
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
