Under the cost-sharing provisions of Kentucky HEALTH, many WellCare members will be required to pay monthly premiums to:
- Remain enrolled in a benefit plan without co-pays OR
- Maintain active benefits
Premiums will typically be paid by the members themselves; however, third parties, including Medicaid providers, are allowed to make premium payments on behalf of members.
Third-party payers may make a payment on behalf of a member through the WellCare guest payment portal. Medicaid providers who are under contract with WellCare may also make a payment on behalf of members through the WellCare Provider Portal.
Any Kentucky Medicaid provider or provider-related entity who wishes to make a premium payment for a member must ensure that their criteria for determining which members they will aid in premium payment meets the following conditions:
- Premium payment may not be conditioned on the volume of services, or the payments received for services previously rendered to the member
- Premium payment may not be conditioned on the likelihood that the member will receive ongoing services from the contributing provider(s) or class of providers(s)
IMPORTANT: The cost of Kentucky HEALTH premium contributions shall not be included in the cost of care for purposed of Medicare and Medicaid cost reporting or as part of a Medicaid shortfall or uncompensated care.