WellCare Health is a Florida-based insurance provider offering Medicare Advantage (Part C) in several states. Wellcare Part C plans include PPOs, HMOs, and SNPs, which may offer additional benefits to Original Medicare (parts A and B).
WellCare offers Medicare Advantage plans in 32 states as well as Medicare Part D plans in all 50 states.
This article explores WellCare’s different Medicare Advantage plan types and provides cost examples for different WellCare plans across the country.
Wellcare is a private insurance company that has been offering various health insurance plans, including Medicare plans, for more than two decades.
According to its website, Wellcare plans enroll over 1.2 million Medicare Advantage and 4.1 million Part D plan enrollees. The Centene Corporation owns Wellcare.
Medicare Advantage (Part C) is an alternative to Original Medicare (parts A and B), which means it has to offer equivalent benefits. That said, WellCare Medicare Advantage plans can vary by state and region, and many of their plans may offer the following additional benefits:
- annual fitness membership
- dental services, including preventive and treatment coverage
- prescription drug coverage
- transportation to doctor’s visits and pharmacies
- vision services and help with glasses and contact lenses
When you are evaluating a particular plan, carefully read the plan’s explanation of benefits to learn about the types of additional services WellCare offers.
The following are examples of Medicare Advantage (Part C) plans available in your area. Plans are region-specific, so WellCare may not offer all plan types in a particular area.
- Health Maintenance Organizations (HMOs): A WellCare HMO plan will involve selecting a primary care provider (PCP) who manages a person’s care. This means the PCP will make referrals to healthcare specialists who are in-network for WellCare. When a person is a member of an HMO, they may pay higher or full costs if they see a doctor who is out-of-network.
- Preferred Provider Organizations (PPOs): These organizations offer reduced rates for in-network providers, but reimbursement is possible for out-of-network ones. Typically, you don’t need a referral to see specialists, but you may need to get pre-authorization, especially for out-of-network providers.
- Special Needs Plans (SNPs): These Part C plans are for specific medical or financial needs. Wellcare offers chronic condition special needs plans (C-SNPs) and dual eligible special needs plans (D-SNPs) for those who are eligible for both Medicare and Medicaid coverage
WellCare offers Medicare Advantage plans in the following states:
The number and type of plans that WellCare offers in these states may vary.
WellCare offers some Medicare Advantage plans at a $0 premium. You must still pay your Medicare Part B premium each month to Medicare but can receive additional services with no monthly premium from WellCare. No matter what premium you pay, you will have deductibles, copayments, or coinsurance for services, as set by your plan and Medicare.
The following table lists examples of WellCare Medicare Advantage plans available nationwide and what you might pay.
Please note: available plans and costs can vary from year to year. If you’re enrolled in a particular WellCare Medicare Advantage plan, the plan will notify you in the fall of any changes to costs.
| City/ plan | Plan | Monthly premium | Health deductible/drug deductible | Out-of-pocket max | Primary doctor copay/coinsurance per visit | Specialist copay/coinsurance per visit |
|---|---|---|---|---|---|---|
| Cleveland, OH: | Wellcare Simple (HMO) | $0 | $0; $420 | $4,700 in network | 0 | $25 |
| Little Rock, AK | Wellcare Patriot Giveback Preferred (HMO) | $0 | $0; $0 | $4,900 in network | $0 | $30 |
| Springfield, MO | Wellcare Simple (HMO-POS) | $0 | $0; $420 | $3,400 in network | $0 | $20 |
How does Wellcare differ from Medicare?
Wellcare offers Medicare Advantage (Part C) plans, which are an alternative to Original Medicare (parts A and B), as well as Part D plans, which cover prescription drugs.
Can you have Medicare and Wellcare at the same time?
You can enroll in a Part C or D plan offered by Wellcare. However, you cannot enroll in Original Medicare through Wellcare, as Parts A and B are offered by the government.
WellCare offers Medicare Advantage in 32 states, and Medicare Part D plans in all 50 states, with plans varying by region.
These plans may include PPOs, HMOs, and SNPs and could help you manage healthcare and prescription drug costs not covered under standard Medicare programs.
You can find out if WellCare offers a plan in your area by searching Medicare’s find a plan tool.