At a glance
- WellCare offers Medicare Advantage plans in 27 states.
- WellCare offers PPO, HMO, and PFFF Medicare Advantage plans.
- The specific plans available to you will depend on where you live.
- WellCare has been acquired by Centene Corporation, which services 23 million members in all 50 states.
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 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 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 plans geared toward those who have a particular medical condition or financial need.
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. 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:
- New Hampshire
- New Jersey
- New York
- North Carolina
- Rhode Island
- South Carolina
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:
- annual fitness membership
- dental services, including preventive and treatment coverage
- prescription drug coverage
- transportation to doctor’s visits and pharmacies
- vision services and help paying for glasses and contact lenses
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 are some examples of WellCare Medicare Advantage plans available across the country and what you might pay in 2021.
|Monthly premium||Health deductible/drug deductible||Out-of-pocket max||Primary doctor copay/coinsurance per visit||Specialist copay/coinsurance per visit|
|Cleveland, OH: WellCare Dividend (HMO)||3.5||$0||$0; $0||$3,450|
|Little Rock, AK: |
WellCare Preferred (HMO)
|Portland, ME: WellCare Today’s Options Advantage Plus 550B (PPO)||3.5||$0||$0; $0||$5,900|
in network;$25 out of network
|$30 in network|
|Springfield, MO: WellCare Premier (PPO)||N/A||$0||$0; $0||$5,900|
out of network
|$0 in network; 40% out of network||$35 in network; 40% out of network with approval|
|Trenton, NJ: WellCare Value (HMO-POS)||3.5||$0||$0; $0||$7,500|
in and out of network
|$5 in network; 40% out of network||$30 in network; 40% 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 (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.
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’s find a plan tool.