WellCare Medicare Insurance Review

Pros Explained

• Low Medicare Advantage premiums: WellCare offers Medicare Advantage plans with $0 premiums, and has one of the lowest average premiums for 2023 of the companies we reviewed—$9.48 per month. 
• HMO, PPO, and PFFS plans available: HMOs strictly limit you to in-network providers while you have more choice with PPO and PFFS plans. Wellcare offers all three options on Medicare Advantage plans.

Cons Explained

• Lowest NCQA rating of the providers we reviewed: WellCare received only a 3 star average rating for its Medicare plans, the lowest of the companies we reviewed.
• Poor J.D. Power rating: WellCare’s parent company, Centene, scored last out of nine insurers in the J.D. Power 2022 U.S. Medicare Advantage Study.
• Few Medicare Advantage plans offer additional gap coverage: Only about a third of Medicare Advantage plans from WellCare offer additional drug coverage when you reach the donut hole phase or Medicare coverage gap. 
• Part D plans don’t include additional gap coverage: While some prescription drug plans offer additional gap coverage, WellCare’s Part D plans do not. That means you’ll be responsible for 25% of the cost of your covered medications during the gap phase of your plan.

Third Party Ratings

WellCare has generally poor third-party ratings when compared to other companies. The company’s Medicare Advantage plans and Part D plans are similarly rated by the Centers for Medicare and Medicaid Services, with a 3.5 star average rating. And the company’s NCQA rating, which measures member experiences across all Medicare plans, was only 3 stars, the lowest of the providers we reviewed. 

What’s more, WellCare’s parent company, Centene, received the lowest score in the J.D. Power 2022 U.S. Medicare Advantage Study. The company was ranked last for customer satisfaction out of nine companies, with a score of 773 out of 1,000. While Centene isn’t rated by AM Best, it is rated by Moody’s, with a grade of Ba1 and a stable outlook. 

Policies Available

Medicare Advantage (Part C) Plans

WellCare offers both HMO and PPO Medicare Advantage plans, but PPOs aren’t as widely available. The company also offers a special needs plan (SNP). Most plans include extra benefits, like vision, dental, hearing, and fitness benefits. 

Many Wellcare plans have $0 primary care copays, and some also offer $0 specialist copays. 

Prescription drug coverage is also available with WellCare Medicare Advantage plans, and a few plans offer additional coverage for select drugs during the gap phase. But other companies offer more plans with additional drug coverage during the Medicare coverage gap, and a better value overall. These are a few reasons why Wellcare is not among the Best Medicare Advantage Plans of 2023.

Part D Prescription Drug Plans

WellCare offers several options for prescription drug plans, but none offer additional drug coverage during the gap phase. Other companies also offer plans with better coverage for the price. For this reason, WellCare was not featured on our list of the Best Medicare Part D Providers. 

Part D plans are a way to get coverage for your prescription drugs if you have Medicare Part A and/or Part B or select Medicare Advantage plans without prescription drug coverage. Drugs are separated into tiers and listed in a formulary, and each plan has different costs associated with each tier of drugs. 

Medicare Supplement Plans (Medigap)

Medicare Supplement plans help cover the cost of copays, coinsurance, and deductibles. Medigap plans are offered by private companies, but are standardized and must follow federal and state laws. Centene offers Medigap plans through a subsidiary, Health Net, but plans have limited availability.

Health Net offers Plan A, D, F, Innovative Plan F, High-Deductible Plan F, Plan G, High-Deductible Plan G, Innovative Plan G, and Plan N. Because of the limited availability and cost, Centene was not included on our list of the Best Medicare Supplement Insurance Companies. 

Cost

Many of Wellcare’s Medicare Advantage plans have $0 primary care copays, and some also offer $0 specialist copays. Premiums as low as $0, and the company’s average Medicare Advantage premium is the second-lowest of all major providers we reviewed at $9.48 per month. 

However, the average drug deductible is $185.10, which is higher than every other provider we reviewed and almost twice the industry average. The average out-of-pocket maximum across Medicare Advantage plans is $5,416.6, which is about $500 higher than the industry average.

WellCare’s Part D plans have low premiums, but don’t offer additional coverage in the Medicare gap. Companies like Aetna and UnitedHealthcare offer better pricing and are also better rated. 

Customer Service

You can reach WellCare by filling out an online form or calling your state-specific customer care line. Select your state at the top right hand corner of this page to get started. Hours are generally between 8 a.m. and 8 p.m. local time, with weekend hours available. 

Methodology

Literature Review

We identified top companies by market share within the industry offering Medicare plans from various business and market insight databases including Statistia, Plunkett, and Gale. We also considered user-generated data from Google to determine public interest and trends in Medicare plans. 

Data Collection and Verification

Our data was collected through third-party rating agencies, official government websites and databases, and directly from companies via websites, media contacts, and existing partnerships. Our sources include: AM Best, the National Committee for Quality Assurance (NCQA), J.D. Power, and the Centers for Medicaid and Medicare Services (CMS).

Data was verified to ensure data integrity and accuracy by cross-referencing the records and citation corresponding to each data point with our primary sources.

Ratings Methodology

We calculated star ratings for the quality of each company’s plan types. Factors considered for companies offering Medicare plans were: 

• Plan quality and customer satisfaction: CMS and NCQA ratings were considered to measure these criteria. Each organization independently rates the quality of Medicare plans on a one-to-five scale to help people compare plans during open enrollment. 
• Cost to value: This is a measure of plan value based on plan premiums, deductibles, maximum out-of-pocket amounts, whether additional drug coverage is offered in the Medicare gap, and star ratings.
• Additional coverage offered in the Medicare gap: The coverage gap or "donut hole" refers to a period when there is a limit on drug coverage. During this time, members are responsible for up to 25% of brand name and generic drugs. You may spend less on prescription drugs if your plan provides additional coverage during the gap.
• State availability: This measure indicates how widely available plans are across the U.S.
• Additional plan benefits: This measure concerns additional benefits available, including vision, dental, hearing, non-emergency transportation, worldwide emergencies, gym memberships, and telehealth. 
• Types of plans available: Insurance companies offer Medicare Advantage plans through managed care organizations, including HMOs and PPOs. This measure concerns the number of managed care options available.
• Special needs plans: This is a measure of whether the company offers plans designed for those with specific diseases.
• Financial strength: This measure accounts for each company’s AM Best financial strength rating to understand how well it’s positioned to pay insurance claims.

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