WellCare is now part of Centene, one of the largest insurers offering government-sponsored insurance. WellCare offers Medicare Advantage plans in a wide geographic footprint. Like many other Medicare insurance providers, WellCare offers a range of products and prices with a rich assortment of extra benefits, making it a reasonable option in many locations. However, some plans do not score especially well on the NCQA health plan rankings, so be sure to check specific ratings of plans in your area.
- Pros & Cons
- Key Takeaways
- Company Overview
- WellCare focuses on government insurance programs, so their Medicare plans are core to their business, not an afterthought.
- Centene acquired WellCare early in 2020, creating one of the largest insurance companies serving people in government insurance programs.
- WellCare’s website lets you shop for any Centene Medicare plans that are available in your area, even if WellCare-branded plans aren’t offered.
WellCare was founded in 1985 in Florida and offers Medicare, Medicaid, and individual Marketplace health insurance plans across the U.S. It was acquired by Centene in 2020, the largest Medicaid plan in the U.S.
The combined company sells Medicare Advantage and Private Fee-for-Service plans in 32 states and Stand-alone Prescription Drug Plans in all 50 states. WellCare operates as Ohana Health Plan in Hawaii and TexanPlus in Texas. Centene offers Medicare plans through AllWell in Illinois, Fidelis Care in New York, and Health Net in California, Oregon, and Washington, among others.
In the 2020 rankings of Medicare Advantage plans by membership, Centene and WellCare were ranked separately; Centene was the ninth-largest and WellCare was the 10th.
WellCare, itself, offers Medicare Advantage plans in 27 states and Stand-alone Prescription Drug Plans in all 50 states and Washington, D.C.
- Year Founded 1985
- Kinds of Plans Medicare Advantage HMO and PPO Plans; Private Fee-for-Service (PFFS) Plans; Stand-alone Prescription Drug Plans (PDP); Dual-eligible Special Needs Plans (D-SNP); Chronic Condition Special Needs Plans (C-SNP); Give Back Plans
- Number of Plans 6
- Payment Options Pay premiums online, by phone, or by mail
- Customer Service By telephone, by mail, or by submitting an online form
- Phone Number WellCare Medicare: 833-444-9088 (TTY: 711); WellCare Medicare Duals Special Needs Plans: 833-444-9089; WellCare Medicare Prescription Drug Plans (PDPs): 888-550-5252; Medicare Rx Saver, Medicare Rx Select and Medicare Rx Value Plus: 833-207-4241
- Official Website www.wellcare.com
- Exclusive focus on government insurance: Both WellCare and its new parent company, Centene, have focused historically on government-sponsored insurance programs including Medicare.
- Broad plan availability through parent-company Centene: The company offers a broad range of Medicare plans across the country in addition to Stand-alone Prescription Drug Plans in all 50 states.
- Flex Cards give members money for extra benefits: WellCare Medicare Advantage members get Visa Flex Cards worth between $200 and $2,500 depending on the plan and location. This money can be used to pay out-of-pocket costs for dental, vision, or hearing services.
- Give Back plans refund Part B premiums: In some areas, WellCare offers dividend plans that return money to members via their Social Security checks or Medicare Part B premium statements.
- Mid-range Medicare Star Ratings: WellCare’s overall CMS average Star Rating is 3.42 out of 5.0.
- Some low-rated plans: NCQA, one of the main health plan accreditation organizations, rates WellCare plans between 2.5 and 3.5 out of 5.0.
- No Medigap options: Some consumers prefer Medicare Supplement Insurance (Medigap) plans. WellCare, though, doesn’t offer these supplemental plans.
WellCare offers several types of Medicare Advantage plans. Most WellCare Medicare Advantage plans include extra benefits like dental, vision, hearing, and fitness.
Like most HMOs, WellCare’s Medicare Advantage HMO plans encourage members to get most of their care from in-network providers; seeing providers who are out of network may be possible but more costly. Members must get referrals from their primary care provider (PCP) to see specialists. WellCare’s HMO plans include pharmacies in their network so you cannot pair HMO plans with Stand-alone Prescription Drug Plans. For 2021, WellCare offers 2,212 Medicare Advantage HMO plans with prescription drug coverage and 447 HMO plans without prescription coverage.
WellCare PPO plans offer wide networks of doctors and hospitals. Because pharmacies are included in those networks, if you have a WellCare PPO plan, you can’t get a separate Part D prescription plan. WellCare PPO members aren’t required to have a PCP and there are no referrals required to see specialists who are in the network. You may be able to get care outside of the network but you’ll likely pay more if you do. For 2021, WellCare offers 1,377 PPO plans with prescription drug coverage and 83 without.
Dual-eligible Special Needs Plans (D-SNP)
Dual-eligible Special Needs plans (D-SNP) offer the benefits of Medicare Advantage with additional benefits the private insurer may choose to include. People who qualify for these plans typically have their costs covered by Medicare and Medicaid. WellCare D-SNPs may provide members with the support of a care manager who can help coordinate care and provide health coaching. These plans also include extra benefits like over-the-counter benefits, meal delivery, and rides to and from doctors and pharmacies. Some D-SNP members qualify for Extra Help, a Medicare program that helps people with lower incomes pay for prescriptions.
Chronic Condition Special Needs Plans (C-SNP)
WellCare offers Chronic Condition Special Needs plans (C-SNP) for members with specific chronic conditions like diabetes, chronic heart failure, and cardiovascular disorder. Like D-SNPs, C-SNPs offer Medicare Advantage benefits plus extras. WellCare offers C-SNP members savings on essentials for managing their condition, like insulin for people with diabetes. They also help coordinate care for members with complex health needs. C-SNP members need to have a PCP who plays a lead role in coordinating the member’s care. WellCare C-SNP plans include prescription drug coverage and have low or no monthly premiums as well as $0-dollar copayments.
Give Back Dividend Plans
In select markets, WellCare offers Give Back plans that refund some or all of the Medicare Part B premiums to members through their Social Security check or as a credit on their Part B premium statement. WellCare offers Medicare Advantage Give Back plans for retired veterans who get free prescriptions through the Veterans Affairs.
Private Fee-for-Service Plans
Like PPO plans, Private Fee-for-Service (PFFS) plans generally don't required you to have a PCP or to get referrals to see specialists. WellCare members on a PFFS plan that doesn’t include prescription drug coverage can enroll in a Stand-alone Prescription Drug Plan. For 2021, WellCare offers 51 PFFS plans with prescription drug coverage in New York and 123 without (in New York and Maine).
Stand-alone Prescription Drug Plans
Stand-alone Prescription Drug Plans (PDP) work alongside Original Medicare Parts A and B.
Most WellCare PDPs have no copayments for Tier 1 drugs at 60,000 in-network retail pharmacies around the country and savings on drugs in other tiers for mail-order prescriptions. WellCare offers seven PDP options which vary in premiums and deductibles, as well as coinsurance amounts for higher-tier drugs.
- Value Script
- Wellness Rx
- Medicare Rx Saver
- Medicare Rx Select
- Medicare Rx Value Plus
Details are available by region and plan. If you sign up for a WellCare PDP and you already have prescription drug coverage in a WellCare Medicare Advantage HMO, PPO, or a PFFS, WellCare automatically disenrolls you from that other plan.
Most WellCare Medicare Advantage plans include extra benefits like dental, vision, and hearing coverage. Many also offer free annual gym memberships and free in-home exercise programs. Many WellCare plans cover telehealth visits the same way they cover in-person visits and offer free transportation to and from medical visits and pharmacies.
Some WellCare plans include discounts on products like medical alert systems and wellness products and services, including acupuncturists, chiropractors, nutritionists, and personal trainers. It offers members a set amount of money for essential items they can buy over the counter, like toothpaste, vitamins, or other over-the-counter medicines or products; members can shop in retail locations or online and have items delivered.
WellCare also offers its Medicare Advantage members the Flex Card, a Visa debit card that comes preloaded with a dollar amount from $200 to $2,500. Members can use the Flex Card for out-of-pocket dental, vision, or hearing costs or other extras that may not be covered.
WellCare has several ways to reach customer service by phone, with different phone numbers for current members and prospective members.
Current Medicare Advantage members can call 833-444-9088 between 8 a.m. and 8 p.m. EST, Monday through Friday from April through September, and seven days a week from October through March.
Dual-eligible Special Needs members can call 833-444-9089 between 8 a.m. and 8 p.m. EST, Monday through Friday from April through September, and seven days a week from October through March.
Prospective Medicare Advantage and D-SNP members can call 866-527-0056 between 8 a.m. and 8 p.m. EST, Monday through Friday from April through September, and seven days a week from October through March.
Prescription Drug Plans
WellCare offers different customer service lines depending on the type of plan.
Members on WellCare Classic, Extra, Value Scrip, and Wellness Rx call 888-550-5252 between 8 a.m. and 8 p.m. EST, Monday through Friday from April through September, and seven days a week from October through March.
Members on Medicare Rx Saver, Medicare Rx Select, and Medicare Rx Value Plus call 833-207-4241 between 8 a.m. and 8 p.m. EST, Monday through Friday from April through September, and seven days a week from October through March.
Prospective Prescription Drug Plan members call 888-293-5151 between 8 a.m. and 8 p.m. EST, Monday through Friday from April through September, and seven days a week from October through March.
WellCare also offers in-person and virtual community events where company representatives explain plan benefits and options. You can meet one-on-one, in-person, or by phone with licensed agents who can explain your options and help you enroll. Prospective members can call 877-823-8267 from 8 a.m. to 8 p.m. EST seven days a week for information or to RSVP for an event.
In its complaint index, the National Association of Insurance Commissioners (NAIC) divides the company’s number of complaints by its share of premiums in the U.S. market. A score of less than 1.0 means the insurer received fewer than expected complaints; a score of greater than 1.0 means they received more.
WellCare’s complaint index for its Prescription Insurance company was 0.07 in 2017, 0.02 in 2018, and 0.04 in 2019 (well below the national average). In the individual health insurance category, this entity received five complaints in 2019, one in 2018, and three in 2017. Other WellCare subsidiaries performed similarly well.
The National Committee for Quality Assurance (NCQA), a leading health plan accreditation organization, rated WellCare plans between 2.5 to 3.5 out of 5.0 in 2020. These composite scores include measures of customer satisfaction, including satisfaction with the consumer’s ability to get needed care, satisfaction with the doctors, and satisfaction with the health plan. Some WellCare plans scored better on their health plan rating than their overall rating.
The overall NCQA rating doesn’t tell the whole story; the score for the overall rating of the health plan may be the best reflection of the health plan’s member experience.
In its 2020 U.S. Medicare Advantage Study, J.D. Power measured member satisfaction with Medicare Advantage plans based on the plans’ coverage and benefits, choice of health care providers, cost, customer service, information and communications, and billing and payment. On the overall customer satisfaction index, WellCare ranked 10th overall with a score of 773 points out of 1,000, placing it last on the top-10 list and below the industry average of 800.
Medicare Star Ratings
The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage and Prescription Drug Plans on a five-star quality rating system. These ratings incorporate member complaints into the overall rating. Star Ratings vary by state, county, and plan.
In the 2021 Star Ratings, WellCare’s plans received between 3.0 and 4.5 out of 5.0 Stars. WellCare plans averaged 3.42 Stars in their overall ratings. WellCare’s Part D Prescription Drug Plans scored better, on average, with a range of 3.0 to 5.0 stars for an overall average of 3.69. WellCare Medicare Advantage plans, in comparison, ranged from 2.0 to 4.0 Stars with an average of 3.24 stars overall. The highest-rated WellCare plans were WellCare of California, which scored 4.5 stars overall, and WellCare of Florida, which scored 4.0 stars overall.
Medicare health plan costs depend on many factors, including where you live, which type of coverage you want, and what insurance company you choose. WellCare’s website lets you compare their Medicare Advantage and Prescription Drug Plan options.
Monthly premiums are the most obvious costs to consider, and many Medicare Advantage plans have low or $0-dollar premiums. Sixty percent of Medicare Advantage Prescription Drug Plan enrollees paid no premium in 2020, and the average premium for all Medicare Advantage enrollees, including those with and without premiums, is projected to be $21 per month in 2021.
Medicare Advantage plans can include copayments, coinsurance, and deductibles. Those other costs can actually outweigh the savings you might have on a $0-premium plan. Many Medicare Advantage plans also offer discounts and other ways to save money, which may contribute to the overall value of the plan.
WellCare’s Medicare Advantage 2021 price ranges include:
HMO plans with prescription drug coverage
- Monthly premiums range from $0 to $81, averaging $6.65; two-thirds of plans have no premium, and nearly one-quarter have premiums of $20 or less.
- Deductibles range from $0 to $445, averaging $169.11; more than half have no deductible.
- Annual out-of-pocket maximums for in-network services range from $500 to $7,550, averaging $4,940.
HMO plans without prescription drug coverage
- WellCare’s HMO plans without prescription drug coverage have no monthly premiums or deductibles.
- Annual out-of-pocket maximums for in-network services range from $3,000 to $6,700, averaging $4,302.
PPO plans with prescription drug coverage
- Monthly premiums range from $0 to $121, averaging $20.63; two-thirds of plans have no premiums.
- Deductibles range from $0 to $445, averaging $95.99; nearly half (43%) have no deductible.
- Annual out-of-pocket maximums for in-network services range from $1,700 to $7,550; averaging $5,313.
PPO plans without prescription drug coverage
- WellCare’s PPO plans without prescription drug coverage have no monthly premiums or deductibles.
- Annual out-of-pocket maximums for in-network services range from $4,000 to $6,700, averaging $5,228.
Private Fee-for-Service plans (PFFS) with prescription drug coverage
- Monthly premiums range from $55 to $156, averaging $105.50.
- These plans do not have deductibles or out-of-pocket maximums, which means there is no cap on what members could have to pay in a year.
PFFS plans without prescription drug coverage
- Monthly premiums range from $0 to $71, averaging $33.66; half these plans have no premiums.
- These plans do not have deductibles or out-of-pocket maximums.
Health plan costs typically require trade-offs; a low-premium plan tends to have higher out-of-pocket costs and vice versa.
Competition: WellCare vs. UnitedHealthcare
WellCare ranks 10th out of the top-10 Medicare Advantage plans by J.D. Power with a score of 773 out of 1,000. UnitedHealthcare ranks fourth with a score of 800, the industry average. WellCare is now part of Centene which extends its geographical reach; UnitedHealthcare has a broader footprint. UnitedHealthcare offers Medicare Supplement Insurance (Medigap) plans, which WellCare does not. UnitedHealthcare also benefits from its exclusive affiliation with AARP.
UnitedHealthcare has higher average Star Ratings from CMS than WellCare and more plans that rate highly. UnitedHealthcare has four 5.0-Star plans and seven 4.5-Star plans; WellCare has one 4.5-Star plan. Those higher-quality UnitedHealthcare plans may cost more; WellCare has more $0-premium plans and lower average costs in many areas. Depending on your priorities, the choice may be clear: UnitedHealthcare wins on quality, WellCare wins on price. But always check the specifics of the plans available in your area. Cost and quality can vary locally.
|Number of States Available (Medicare Advantage)||27||47|
|Customer Service Options||By telephone, by mail, or by submitting an online form||Telephone, online, in-person, chat|
|AM Best Rating||N/A||A- (Excellent)|
|Average CMS Star Rating||3.42||3.78|
WellCare has been focused on the Medicare market for decades and serving Medicare enrollees for most of its existence. They offer Medicare Advantage and Stand-alone Prescription Drug Plans in a wide geography, with many low-premium or low-cost options and robust extra benefits. However, watch the quality ratings in your area. Though complaints are generally low, few consumers seem wowed by their experiences with WellCare. The new Centene ownership offers them greater scale which could create more benefits to members over time.
How We Reviewed Medicare Providers
Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index, and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.
Kaiser Family Foundation. “10 Things to Know about Medicaid Managed Care.” Accessed Jan. 11, 2021.
The Health Care Blog. “Why the Centene and WellCare Merger is the Biggest Deal in 2020.” Accessed Jan. 11, 2021.
Center for Medicare & Medicaid Services. “Part C and D Performance Data, 2021 Star Ratings Data Table.” Accessed Jan. 11, 2021.
Medicare.gov. “Find your level of Extra Help (Part D).” Accessed Jan. 11, 2021.
National Association of Insurance Commissioners. “WellCare Prescription Ins Inc National Complaint Index Report.” Accessed Jan. 11, 2021.
NCQA. “NCQA Health Insurance Plan Ratings 2019-2020 – Summary Report (Medicare).” Accessed Jan. 11, 2021.
J.D. Power. “Medicare Advantage Plans Struggle to Communicate Effectively with Members, J.D. Power Finds.” Accessed Jan. 11, 2021.
Centers for Medicare & Medicaid Services. “Trump Administration Announces Historically Low Medicare Advantage Premiums and New Payment Model to Make Insulin Affordable Again for Seniors.” Accessed Jan. 11, 2021.
Kaiser Family Foundation. “Medicare Advantage 2021 Spotlight: First Look.” Accessed Jan. 11, 2021.