What Is WellCare Medicare?

Nov 19, 2023 By Susan Kelly

Plans for Medicare Advantage are available via WellCare across a large geographic footprint. WellCare, like many other Medicare insurance providers, provides a variety of goods and pricing along with a broad collection of additional benefits. This makes WellCare a sensible choice in many different areas since it is an affordable alternative. Hence, it is important to verify the detailed ratings of the available programs in your region.


The Positives Exposed


Traditionally concentrated their efforts on government-sponsored insurance programs such as Medicare throughout their history. Wide range of plan options available via Centene, the company's parent: In addition to providing Medicare and Stand-alone Prescription Drug Plans in all fifty states, the firm offers a comprehensive selection of Medicare plans nationwide.


Defining the Drawbacks


Ratings in the middle of the pack for Medicare: WellCare overall CMS average Star Rating in 2022 is 3.42 out of 5.0, while California gave it a perfect score of 5 stars.


  • Some designs with poor ratings: The National Committee for Quality Assurance (NCQA), one of the most important organizations that certify health plans, gives WellCare plans ratings of between 2.5 and 3.5 out of 5.0 for customer satisfaction and care.
  • There are no other Medigap choices available: Medicare Supplement Insurance (Medigap) policies are favored by certain Medicare beneficiaries. However, WellCare does not provide these additional plan options to its customers.


Available Plans


There are several distinct Medicare Advantage plan options available via WellCare. Most WellCare Medicare Advantage plans provide additional benefits, such as fitness, hearing, vision, and dental coverage.


HMO Strategies


The Medicare Advantage HMO plans offered by WellCare, like most HMOs, encourage members to get most of their treatment from in-network doctors. Visiting physicians not part of the network may be feasible, but it will be more expensive. To see a specialist, members must get recommendations from their primary care physician (PCP). Because the HMO plans offered by WellCare include pharmacies as part of its network, it is not possible to combine HMO plans with standalone prescription drug coverage.


Plans for Special Needs Related to Chronic Conditions (C-SNP)


Members with particular chronic diseases, such as diabetes, chronic heart failure, and cardiovascular problem, are eligible for the Chronic Condition Special Needs plans (C-SNP) made available by Well Care. C-SNPs, much like D-SNPs, provide the benefits of Medicare Advantage and other advantages. Members of the C-SNP may get discounts from WellCare on necessary management of their disease, such as insulin in the case of diabetics. They also assist in coordinating care for members with complicated medical requirements.


Give Back Dividend Plans


Members may get a refund of part or all of their Medicare Part B premiums via their Social Security check or as a credit on their Part B premium statement if they enroll in one of WellCare's Give Back programs, which are available in certain regions. WellCare provides plans under the Medicare Advantage Give Back program for retired veterans eligible for free medicines via the Veterans Affairs program.



Private Plans That Are Paid on a Per-Service Basis


Private fee-for-service (PFFS) plans are similar to PPO plans in that they do not need you to have a primary care physician (PCP) or to acquire referrals to visit specialists. Members of WellCare with a PFFS plan that does not include coverage for prescription drugs have the option of enrolling in a Standalone Prescription Drug Plan.


Individual Prescription Drug Insurance Plans


The majority of the WellCare PDPs provide no copayments for Tier 1 pharmaceuticals at any of the 60,000 in-network retail pharmacies across the nation. Additionally, mail-order prescriptions qualify for discounts on drugs from other tiers. WellCare provides seven different PDP alternatives, each with a unique combination of premiums, deductibles, and coinsurance rates for higher-tier medications.


Extra Benefits


Extra benefits, including dental, vision, and hearing coverage, are often included in most WellCare Medicare Advantage plans. Many of them also provide free in-home workout regimens and complimentary yearly club memberships. A number of the WellCare plans provide coverage for telehealth visits in the same manner that they provide a range for in-person visits. Furthermore, these plans often include free transportation to and from medical appointments and pharmacies.


Assistance to Customers


There are several methods to get in touch with customer support via phone at WellCare, and existing members and potential members each have their dedicated phone number.


Medicare Advantage


Eastern Standard Time, Monday through Friday from April through September and seven days a week from October through March, is available to current Medicare Advantage members.


Insurance Coverage for Prescription Drugs


Members of WellCare Classic, Extra, Value Scrip, and Wellness Rx can reach customer service by dialing 888-550-5252 between 8:00 a.m. and 8:00 p.m. Eastern Standard Time (EST) Monday through Friday from April through September, and seven days a week during October through March.


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