What Is Wellcare Medicare? Key Features, Pros, Cons And Plan Types Explained

Wellcare Medicare is a subsidiary of Centene Corporation.

It offers various Medicare Advantage plans with features like dual access for Medicare and Medicaid beneficiaries, benefit-rich options, and budget-friendly out-of-pocket maximums.

Explore Wellcare’s plan types, coverage, and key features to make informed decisions about your healthcare options.

What Is Wellcare Medicare?
What Is Wellcare Medicare: Photo(Medigap)

Key Features 

Benefit-Rich Plans

Wellcare Medicare Advantage plans typically offer comprehensive benefits, including coverage for dental, vision, and hearing services.

Dual Access

As a prominent Medicare insurance provider, Wellcare provides Dual-Eligible Support Needs Plans (D-SNPs) tailored for individuals qualifying for both Medicare and Medicaid.

Budget Friendliness

Wellcare Medicare Advantage plans feature a relatively low out-of-pocket maximum, setting a cap on the amount payable for covered healthcare services within a plan year.

Savings may vary by state and county.

Also Read: What is the Cost of a Dermatologist Appointment Without Insurance?: Exploring Affordable Options for Skincare Consultations

Wellcare Medicare Advantage plans Pros And Cons

Pros:

Company Strength:

After Centene’s acquisition of Wellcare in 2020, the combined entities secured 4.4% of the Medicare Advantage market in 2023.

Funds for Extra Benefits:

Some Wellcare plans provide a Spendables card with preloaded funds;

This allows members to cover expenses such as over-the-counter items, groceries, rent or utility assistance, gasoline, or dental, vision, and hearing benefits, depending on the specific plan.

Part B Premium Coverage:

Certain plans offer a Giveback benefit, refunding a portion or the entirety of the Medicare Part B premium.

Cons:

Low Star Ratings:

Wellcare’s average star rating for 2024, as assessed by Medicare, is 3.03 stars (out of 5 stars), compared to the overall Medicare Advantage plans’ average of 4.04 stars.

Member Discontent:

Member experiences regarding care coordination and customer service metrics fall below average.

Limited State Coverage:

Wellcare provides Medicare Advantage plans in 37 states and support needs plans (SNPs) in 33 states.

Also Read: Is Gemtesa Covered By Medicare? Navigating Medicare Coverage for Overactive Bladder Relief

Plan Types

Wellcare provides a range of Medicare Advantage plan types with differing structures, costs, and benefits.

The offerings encompass Medicare Advantage prescription drug plans (MAPDs), stand-alone prescription drug plans, and Medicare Advantage plans without drug coverage.

  1. HMO Plans:
    • Requires the use of a specific network of doctors and hospitals.
    • Referral from a primary doctor may be necessary for specialist visits.
    • Limited out-of-network benefits.
  2. HMO-POS Plans:
    • HMO plans with some out-of-network services available.
    • Members incur higher costs for out-of-network services.
  3. PPO Plans:
    • Preferred provider organization plans offer flexibility to see any accepting provider.
    • No need to choose a primary doctor, and referrals for specialists are not required.
    • Out-of-network care is possible, but it may cost more than in-network services.
  4. PFFS Plans:
    • Private fee-for-service plans permit visits to any Medicare-approved provider accepting Wellcare.
    • No requirement to select a primary doctor, and no referral needed for specialists.
  5. SNPs (Support Needs Plans):
    • Restrict membership based on specific diseases or characteristics.
    • Benefits, network, and drug formularies cater to the unique needs of members.
    • Wellcare offers two SNP types:
      • Chronic Condition SNP: Tailored for members with chronic conditions like diabetes, congestive heart failure, and cardiovascular disorders.
      • Dual-Eligible SNP: Intended for individuals eligible for both Medicare and state Medicaid assistance.

Summary

Wellcare, established in 1985, became a subsidiary of Centene in 2020, with its headquarters located in Tampa, Florida.

Specializing in Medicaid, Medicare Advantage, and Medicare prescription drug plans, Wellcare is a significant player in the healthcare sector.

Under Centene’s umbrella, Wellcare serves over 1.3 million Medicare Advantage members.

In the fiscal year 2022, Centene reported total revenues amounting to $144.5 billion.

Spread the love