Navigating the landscape of healthcare benefits can be complex, especially when it comes to understanding Over-the-Counter (OTC) and healthy food benefits offered through plans like Fidelis Care and Wellcare. This article aims to provide a detailed overview of these benefits, eligibility requirements, and upcoming changes, particularly focusing on Dual Special Needs Plans (D-SNPs).
The Fidelis OTC Card: Your Gateway to Affordable Healthcare Products
Fidelis Care provides eligible members with an OTC card, offering discounted rates on over-the-counter medicines. This card comes with a monthly or quarterly allowance, enabling members to purchase essential healthcare items without straining their finances. The Fidelis OTC card allows members to buy over-the-counter items online and at retail stores. The balance is loaded into the OTC card monthly or quarterly.
How to Use Your Fidelis OTC Card
Fidelis Care provides multiple convenient ways for members to utilize their OTC benefits:
- Online: Purchase items through the online portal.
- In-Store: Visit participating retail locations to buy eligible items.
- By Phone: Call the Fidelis Care OTC customer service line at (855) 402-4806. Members will need to provide their member ID and other necessary information.
The OTC card number is printed on the back of the card for easy reference.
Wellcare Spendables® Card: Expanding Your Healthcare Options
Wellcare, the Medicare brand for Centene Corporation, offers the Wellcare Spendables® Card, designed to help reduce out-of-pocket expenses for eligible healthcare needs. This card can be used for over-the-counter (OTC) items and eligible dental, vision, and hearing services.
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Flexibility and Convenience
The Wellcare Spendables® Card offers multiple ways to shop:
- In-store: At participating retailers.
- Online: Through the online portal.
- Mobile app: Via the dedicated mobile application.
- Over the phone: By calling the customer service line.
Healthy Food Programs: Nourishing Your Well-being
Many Medicare Advantage plans recognize the importance of nutrition in overall health and offer healthy food programs to support members in accessing nutritious food options.
Wellcare's Healthy Food Program
Wellcare's Healthy Food Program engages food-insecure members by encouraging healthy food purchases. Members automatically receive a prepaid card used to buy healthy foods at certain retailers. The available funds, which vary by plan ($25 or $50), replenish each month. No prior authorization or referral is needed.
Dual Special Needs Plans (D-SNPs): Tailored Support for Specific Needs
Dual Special Needs Plans (D-SNPs) are designed for individuals who are eligible for both Medicare and Medicaid. These plans often include additional benefits and resources to address the unique healthcare needs of this population. Wellcare Fidelis Dual Align provides coordinated patient-centered care. Members will be given a care manager, who works for Wellcare By Fidelis Care and whose responsibility it is to make sure the member receives the help he or she needs. To enroll in Wellcare Fidelis Dual Align plan, you will need a Conflict Free Evaluation and Enrollment Center Evaluation.
UnitedHealthcare D-SNP Changes in 2026
It's crucial to be aware of upcoming changes to D-SNP benefits. Through 2025, UnitedHealthcare D-SNP members receive a monthly credit to help pay for OTC products, healthy food, and utility bills. However, in 2026, due to an industry-wide change, members will need to have a qualifying chronic health condition to spend credits on healthy food and utilities.
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Qualifying for Healthy Food and Utility Benefits in 2026
In 2026, the Centers for Medicare and Medicaid Services (CMS) is ending a program called the Value-Based Insurance Design (VBID) model. This program helped health plans give extra non-medical benefits, like credits for healthy food and utilities. Qualifying conditions may vary by carrier.
If you’re already a UnitedHealthcare D-SNP member, the company will try to verify if you have a qualifying condition using the information they have. To ensure you qualify, you’ll need to either go online or call UnitedHealthcare to self-indicate a condition. Then, they’ll work with your treating physician to verify your condition. If you’re enrolling in a UnitedHealthcare Dual Special Needs plan for the first time, you may be asked to fill out the Additional Benefit Verification Form when you enroll. This release gives UnitedHealthcare permission to access things like your claims data and other files to find any prior diagnoses that may meet the SSBCI criteria.
Continued Benefits
Even with these changes, you’ll still keep your UnitedHealthcare Dual Special Needs plan. You don’t need a qualifying condition to stay enrolled or to keep your full monthly credit for OTC products - it will still be added to your UnitedHealthcare UCard® every month. Plus, you can use your monthly credit on wellness support like select fitness items. Or, get assistance through The Helper Bees for in-home services, weight management counseling, caregiver relief and more.
Understanding Drug Formularies and Tiers
A drug formulary is a list of medications covered by a specific plan. These medications are often categorized into different tiers, each with a distinct price.
Wellcare By Fidelis Care Drug Tiers
For all Wellcare By Fidelis Care plans, prescription drugs are grouped into one of five tiers. To find out which tier your drug is in, consult the formulary.
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- Tier 5 (Specialty Tier): Includes high-cost brand and generic drugs.
You won’t pay more than $35 for a one-month supply of each covered insulin product on this tier.
Special Supplemental Benefits for the Chronically Ill (SSBCI)
Some of the benefits mentioned, such as the Wellcare Spendables® Card, are part of Special Supplemental Benefits for the Chronically Ill (SSBCI). Eligibility requirements must be met before these benefits are provided.
Navigating Changes and Ensuring Access to Benefits
Change can be daunting, but resources are available to help you navigate these transitions. If you have questions about your eligibility or how to access your benefits, contact your plan provider for assistance.