WellCare Health Plans is a Tampa, Florida-based insurance provider that offers Medicare Advantage (Part C) and Medicare Part D (prescription drug) plans to Medicare beneficiaries in several states.

This article will explore the different Medicare Advantage plan types that WellCare offers, as well as provide some examples of costs under different WellCare plans across the country.

The following are examples of types of Medicare Advantage plans that may be available in a person’s coverage area. Plans are usually very region-specific, and WellCare may not offer all plan types in a particular area.

WellCare Medicare Advantage HMO plans

WellCare offers Health Maintenance Organization (HMO) plans as part of their Medicare Advantage offerings. Typically, 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.

WellCare Medicare Advantage PPO plans

WellCare offers Preferred Provider Organization (PPO) plans in states including Florida, Georgia, New York, and South Carolina. These organizations offer reduced rates for choosing in-network providers, yet a person may still receive reimbursement if they see out-of-network providers.

Typically, a person will not have to obtain a referral to see a specialist. However, there may be instances where getting a referral or obtaining pre-authorization for a procedure may be encouraged, especially if the provider is an out-of-network one.

WellCare Medicare Advantage Special Needs Plans

Special Needs Plans (SNPs) are Medicare Advantage plan types geared toward those who have a particular disease or medical condition. Examples include a person with end-stage renal disease or congestive heart failure. These plan types usually offer extra services that are specifically geared toward a person’s medical condition.

WellCare Private Fee-for-Service (PFFS) plans

WellCare offers plans in select areas of the country. This is a plan that usually offers a set rate for what it will pay hospitals and doctors for services, with a set copay, or coinsurance, the policyholder will pay as well.

A PFFS plan may have a provider network or a person may be able to see any provider they choose. The provider must usually accept assignment from Medicare or accept the PFFS plan’s terms for what it will pay.

WellCare offers Medicare Advantage plans in several states. These include:

  • Alabama
  • Arizona
  • Arkansas
  • California
  • Connecticut
  • Florida
  • Georgia
  • Hawaii
  • Illinois
  • Indiana
  • Kentucky
  • Louisiana
  • Maine
  • Michigan
  • Mississippi
  • Missouri
  • New Hampshire
  • New Jersey
  • New York
  • North Carolina
  • Ohio
  • Rhode Island
  • South Carolina
  • Tennessee
  • Texas
  • Vermont
  • Washington

The number and type of plans that WellCare offers in these states may vary.

WellCare Medicare Advantage plans can vary by state and region. However, many plans offer the following benefits in addition to Medicare parts A and B. These include:

When you are evaluating a particular plan, carefully read the plan’s explanation of benefits so you can see the types of additional services WellCare offers.

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, co-payments, or co-insurance for services as your plan and Medicare set forth.

The following are some examples of WellCare Medicare Advantage plans available across the country, as listed on the Medicare Plan Finder site.

Samples costs from a few WellCare Medicare Advantage plans in 2021

Monthly premiumHealth plan deductibleDrug plan deductibleOut-of-pocket maxPrimary doctorSpecialist
Cleveland, OH, WellCare Dividend (HMO)3.5$0
(with drug coverage)

copay per visit
copay per visit
Little Rock, AK,
WellCare Preferred (HMO)
(with drug coverage)
copay per visit
copay per visit
Portland, ME, WellCare Today’s Options Advantage Plus 550B (PPO)3.5$0
(with drug coverage)
in-network copay per visit / $25 out-of-network
$30 in-network
copay per visit/ $50 out-of-network
Springfield, MO, WellCare Premier (PPO)N/A$0
(with drug coverage)
(in-network) /
$0 in-network
copay per visit / 40% coinsurance out-of-network
$35 in-network
copay per visit/ 40% coinsurance out-of-network with approval
Trenton, NJ, WellCare Value (HMO-POS)3.5$0
(with drug coverage)
(in- and out-of-network)
$5 in-network
copay per visit/ 40% coinsurance per visit out-of-network
$30 in-network
copay per visit/ 40% coinsurance per visit out-of-network with approval

Available plans and costs can vary from year to year. If you have a particular WellCare Medicare Advantage plan, the plan will notify you in the fall of any changes to costs.

Medicare Advantage, or Medicare Part C, is a “bundled” health plan where a private insurance company is responsible for providing a person’s Medicare coverage. Medicare Part C usually includes Part A (hospital coverage), Part B (medical coverage), and Part D (prescription drug coverage). However, some WellCare plans don’t cover Part D.

When you purchase a Medicare Advantage plan, Medicare pays your insurance company of choice to provide you with health benefits. To stay competitive, your insurance plan may offer you extra benefits not available in original Medicare. These include services such as dental, vision, or hearing coverage.

Companies that offer Medicare Advantage often contract with doctors and hospitals to negotiate costs for medical services. If a doctor or hospital agrees to provide services at a certain rate with the insurance company, the company will usually designate them as an “in-network” provider.

Medicare Advantage plans are very state- and region-specific because of the way a plan negotiates with hospitals and doctors in each area. As a result, not all plan types WellCare offers are available in all states.

Medicare Part D is the portion of Medicare that provides prescription drug coverage. Medicare requires all people age 65 and older have some form of prescription drug coverage. If you choose prescription drug coverage through Medicare Advantage, you don’t have to buy a separate Part D policy.

Each insurance company that offers prescription drug coverage has a formulary. This is a list of medications that you can purchase at a lower cost. Medicare requires an insurance company have at least two common medications in most drug categories. If you are considering a WellCare Medicare Advantage plan, it’s important to read the formulary to make sure the plan covers all or most medicines you take.

WellCare offers Medicare Advantage and Medicare Part D plans in 27 states, with plans varying by region. These plans may include PPOs, HMOs, and PFFFs, 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.gov’s Find a Medicare plan search tool.

This article was updated on October 21, 2020 to reflect 2021 Medicare information.


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