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

WellCare offers Medicare Advantage plans in 36 states, and Medicare Part D plans in all 50 states. The plans vary by region and may include PPOs, HMOs, and PFFFs

This article explores the different Medicare Advantage plan types that WellCare offers, and provides cost examples under different WellCare plans across the country.

The following are examples of Medicare Advantage plans that may be available in your area. Plans are region-specific, WellCare may not offer all plan types in a particular area.

WellCare 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 PPO plans

WellCare offers Preferred Provider Organization (PPO) plans in most states. 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 plans geared toward those with particular medical conditions or financial needs.

Here are the different types of SNPS available for those who meet the criteria:

  • Chronic Condition Special Needs plans (C-SNPs): for people with chronic health conditions
  • Institutional Special Needs plans (I-SNPs): for people who live in nursing homes or long-term care facilities
  • Dual Eligible SNPs (D-SNPs): for patients who are eligible for both Medicare and Medicaid coverage

These plans each offer comprehensive hospitalization, medical service, and prescription coverage but have been separated based on the patients they serve.

WellCare Private Fee-for-Service plans

WellCare offers plans in select areas of the country. These plans usually offer a set rate for what they 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 an assignment from Medicare or accept the PFFS plan’s terms for what it will pay.

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, copayments, or coinsurance for services, as set by your plan and Medicare.

The following table lists some examples of WellCare Medicare Advantage plans available across the country 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
Star
rating
Monthly premiumHealth deductible/drug deductibleOut-of-pocket maxPrimary doctor copay/coinsurance per visitSpecialist copay/coinsurance per visit
Cleveland, OH: WellCare Dividend Giveback (HMO)3.5$0$0; $480
$4,350
in network
20%20%
Little Rock, AK:
Wellcare No Premium Preferred (HMO)
3.5$0$0; $0$6,000
in network
$0$35
Springfield, MO: WellCare No Premium (HMO)4$0$0; $0$5,000
in network
$0
in network; $25 out of network
$30 in network; $50 out of network
Trenton, NJ: WellCare Assist (HMO)4$0$0; $0
$6,700
$0$35
Trenton, NJ: Wellcare Assist (HMO)3.5$18.20$0; $480$7,550$0$35

Medicare Advantage (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 how the plan negotiates with hospitals and doctors in each area. As a result, not all plan types WellCare offers are available in all states.

WellCare offers Medicare Advantage in 36 states and Medicare Part D plans in all 50 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’s Find a plan tool.