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Kat Casna

WellCare serves more than 4.6 million Medicare beneficiaries, but only 556,519 of those enrollees have Medicare Advantage plans—the rest chose a standalone Part D plan.1

WellCare’s Medicare Advantage plans average 3.3 out of 5,2 which is low considering 95% of Medicare Advantage beneficiaries have a plan rated 3.5 or better.3 Despite lackluster ratings, WellCare offers a wide variety of plans and coverage options. However, WellCare has Medicare Advantage plans in only 18 states, and many of its plans are available in only a handful of those states.

If you do live in a state WellCare serves and discover a high-rated plan that fits your situation, WellCare could be a good health insurance option.

States WellCare serves

  • Alabama
  • Arizona
  • Arkansas
  • California
  • Connecticut
  • Florida
  • Georgia
  • Hawaii
  • Illinois
  • Kentucky
  • Louisiana
  • Maine
  • Mississippi
  • New Jersey
  • North Carolina
  • South Carolina
  • Tennessee
  • Texas

Is a WellCare Medicare Advantage plan right for you?

WellCare plans aren’t for everyone, but some groups may find this insurer’s coverage a good fit:

  • People who want an HMO: Most of WellCare’s Advantage plans are Health Maintenance Organizations (HMOs).
  • People who want drug coverage: Most WellCare insurance also includes Medicare prescription drug coverage.
  • People who find a high-rated plan: While Wellcare’s average Medicare Star Rating is low compared to plans most people are enrolled in4, a few plan options have 4 or more stars.

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WellCare Medicare Advantage plans

If we deep dive into WellCare’s Star Ratings, we find that some of this health insurer’s highest scores are for price accuracy, appeals, and accessibility. Some of the lowest scores are for specific treatments (such as osteoporosis, rheumatoid arthritis, and controlling blood pressure). WellCare plans also score low for Special Needs Plan (SNP) care management and receiving appointments and care quickly.

WellCare Medicare sample plans

Location
Drug coverage
Deductible
Out-of-pocket maximum
Doctor visit
Network
Plan #
Learn more
WellCare TexanPlus Classic (HMO)
WellCare Access (HMO-SNP)
WellCare Advance (HMO-POS)
WellCare Today’s Options Premier 200 (PFFS)
WellCare Today’s Options Advantage Plus 550B (PPO)
Houston, TX 77021 Atlanta, GA 30324 Louisville, KY 40203 Portland, ME 04104 Portland, ME 04104
Yes Yes No No Yes
$0 $0 $100 $0 $0
$3,400 $6,700 $5,000 $5,000 $4,000 in network, $6,700 out of network
$0 $0 $0 $0 in network, $10 out of network $5 in network, $25 out of network
Must stay in network Must stay in network Lower costs for in-network services Lower costs for in-network services Lower costs for in-network services
H4506-003 H1112-006 H9730-006 H2816-033 H27775-103
Get started Get started Get started Get started Get started

Sample plans based on WellCare.com and are for illustration purposes only. Actual plans may vary. Not all plans available in all areas. Data effective 5/13/19.

If you don’t mind waiting for appointments, don’t need an SNP, and don’t have one of the health issues WellCare scores poorly for, this insurer may be a fine choice.

Generally, WellCare offers a variety of HMOs, as well as some PFFS plans. WellCare also offers PPO plans, but we didn’t come across many among the plans we sampled. Depending on where you live, the WellCare plans available to you may have different names—like Easy Choice in California or Ohana in Hawaii—and different benefits.

WellCare offers a variety of plans nationwide, but the five we sample below give a range of possibilities.

WellCare TexanPlus Classic (HMO)

This plan is available in—you guessed it—Texas. With a $0 deductible, coverage kicks in right away with $0 visits to your primary care physician (PCP). And your out-of-pocket costs for the year cap out at $3,400. This plan also includes prescription drug, hearing, dental, and vision coverage.

The TexanPlus Classic HMO stands out from many other WellCare options because it earns a Medicare Star Rating of 4.5 out of 5.

HMO Advantage plans like this one require enrollees to stay in WellCare’s network of providers to receive coverage for all services except emergency and urgent care situations. If you’re a Texan, don’t mind staying in a network, and want a quality plan, this one could be a good option.

WellCare Today’s Options Advantage Plus 550B (PPO)

Like other PPO Advantage plans, this plan has a network of preferred providers but allows beneficiaries to receive care outside that network at a higher cost. As a result, enrollees may see separate deductibles, copayments, and coinsurance for in-network and out-of-network services.

The plan we sampled had WellCare’s standard $0 deductible, but unlike other plans, this PPO doesn’t have $0 doctor visits, even if you stay in network. It’s $5 to see your primary care physician, but that price jumps to $25 if you leave the network.

Like many other WellCare plans, this one includes prescription drug, vision, dental, and hearing benefits.

If you want the savings of WellCare’s provider network as well as the freedom to choose providers outside that network, this plan might be a good choice for you.

WellCare Access (HMO-SNP)

This plan is a Special Needs Plan designed for dual eligibles—people who have both Medicare and Medicaid. It’s also a managed care plan, meaning a plan representative will help you coordinate doctor visits, prescriptions, and more.

This plan’s out-of-pocket maximum is the highest Medicare allows ($6,700 in 20195), but it’s offset by WellCare’s usual $0 deductible and $0 doctor visits. WellCare Access also covers prescriptions, hearing, dental, and vision.

If you have both Medicare and Medicaid and think your annual health care costs will be higher than $6,700, this could be a good fit for you.

WellCare Advance (HMO-POS)

Of all the plans we sampled, this was the only one with a deductible—but it’s a low $100. Drug coverage isn’t included, but hearing (in-network only), dental, and vision are.

Like other HMOs, this plan has a network of providers. Unlike other plans, this one comes with a Point-of-Sale (POS) option. That means, if you go out of network for care, you can still receive some coverage—35% of Medicare’s maximum allowable cost. That could become pricey for regular doctor visits and services, but for the occasional niche specialist or services you need while traveling, POS can be a useful feature.

WellCare Today’s Options Premier 200 (PFFS)

WellCare’s Private-Fee-for-Service (PFFS) plans are like Original Medicare in that you can seek care from any provider that accepts Medicare, provided they agree to accept your plan before delivering care. Unlike other PFFS plans, however, this one also offers an optional network of providers. Enrollees who stay in this network may have lower health care costs than those who don’t.

In addition to everything Medicare Parts A and B cover, this plan also offers hearing, dental, and vision benefits. It does not, however, cover prescription drugs.

PFFS plans aren’t for everyone for one compelling reason: doctors aren’t required to accept this health insurance. That means you’ll need to have written confirmation from each provider you use, before every service—or risk having to foot the bill yourself. But if you feel the freedom to receive care out of network is worth the effort to obtain this confirmation, this plan could work for you.

Bottom line: A few high-quality gems among low average Star Ratings.

While WellCare offers a variety of plan Medicare Advantage plans in 18 states, this insurer doesn’t come highly rated overall.

WellCare does some things better than others. Medicare gives it high Star Ratings in administrative and customer service categories7, but when it comes to delivering care, WellCare falls short in many areas.

Still, if this company offers a hard-to-find plan type you’re looking for (like a PFFS or HMO-POS), or you find a gem with high Star Ratings, WellCare could be right for you.

Either way, call a licensed sales agent to help you find and compare plans in your area to find the right fit.

Get A Quote


OR

Call to speak with a Licensed Agent

855-802-1206

Want to learn more about WellCare or Medicare? Check out these other pages to fill in the gaps.

WellCare FAQ

Is Medicare Advantage better than Original Medicare?

Which form of Medicare coverage is best depends on your unique situation, but by law, Medicare Advantage must cover all the benefits Original Medicare does. And many Advantage plans come with additional benefits such as vision and dental coverage.

Read our guide if you’re considering Original Medicare vs. Medicare Advantage.

When can I enroll in Medicare Advantage?

If you know you want Medicare Advantage as soon as you have Medicare eligibility, you can enroll in Medicare Advantage during your Initial Enrollment Period (IEP). This period begins three months before you’re eligible for Medicare and runs for seven months.

If you’re switching to a Medicare Advantage plan from Original Medicare after your IEP, you can use the annual Medicare Open Enrollment period from October 15 through December 7 each year.

Sources

1. Centers for Medicare and Medicaid Services, “Enrollment by Contract
2. Center for Medicare and Medicaid Services, “Part C and D Performance Data
3. Kaiser Family Foundation, “A Dozen Facts About Medicare Advantage
4. Kaiser Family Foundation, “A Dozen Facts About Medicare Advantage
5. National Council on Aging, “A Guide to Medicare Advantage/Part C Costs
6. Center for Medicare and Medicaid Services, “Part C and D Performance Data

Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively “Medicare System Providers”). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.