Who Is WellCare?
WellCare is among the giants in managing government healthcare plans. WellCare health plans launched in 1985 to meet Florida’s need for a Medicaid provider. It grew from there.
By 1997 — long before Medicare expanded to include Medicare Advantage plans — WellCare offered Medicare beneficiaries private health insurance plans. After the signing of the Medicare Prescription Drug, Improvement and Modernization Act in 2003, it officially added Medicare Advantage plans to its offerings. Then in 2006, it started selling Part D Medicare prescription drug plans.1
Centene Corp. acquired WellCare in January 2020, making WellCare a wholly-owned subsidiary of Centene, operating in 27 states. As a combined company, it has 24 million clients in all 50 states.2
Of the two companies, WellCare has long been a larger provider of Medicare Advantage plans than Centene. Since the acquisition, Centene uses WellCare’s base to increase the company’s business in this area, including ramping up WellCare’s business.3
What Health Insurance Plans Does WellCare Offer?
WellCare offers several types of Medicare Advantage plans, including health maintenance organizations (HMO), preferred provider organization plans (PPO) and private fee for service plans (PPFS).
It also sells Medicare prescription coverage, Part D, which generally people purchase who neither buy additional Medicare coverage beyond the basics nor choose a Medicare supplement plan, which WellCare doesn’t sell.
WellCare HMO plans: These plans are generally the least expensive with many of them charging no more than the Medicare Part B fee deducted automatically from a Social Security recipient’s monthly benefit. WellCare HMOs require patients to select a primary care provider (PCP) who manages their care. The PCP will make referrals to healthcare specialists who are in the WellCare network. If patients in a WellCare HMO plan choose a healthcare provider who is out of network, they will pay higher or even full costs.
WellCare PPO plans: These plans give a patient more freedom to choose healthcare providers. PPOs don’t require a participant to have a primary care physician or get a referral to see a specialist. These plans offer reduced rates for choosing in-network providers, but if you see a doctor outside of the network, you’ll generally get partial reimbursement. The cost of a WellCare PPO plan depends on where you live and the details of its benefits.
WellCare PPFS plans: In certain states, particularly California, WellCare offers PPFS plans. Healthcare providers working with these plans agree to accept what WellCare is willing to pay. Patients who see a provider who isn’t participating won’t get any reimbursement.
WellCare Medicare Advantage plans: Medicare Advantage offers special needs plans for people in these circumstances:
- Chronic Health Conditions and Disabilities (C-SNPs). These HMO-type plans cover people of all ages who receive Medicare because they have chronic health conditions.
- Institutional Special Needs (I-SNPs). These cover people of all ages who live in nursing homes or long-term care facilities.
- Dual Eligible (D-SNPs). These cover people who are eligible for both Medicare and Medicaid (Here’s help understanding Medicaid.).4
Leader in Medicare Advantage Plans
These include plans for chronic health conditions and disabilities, institutional special needs and for people with dual eligibility.
What Are the Member Benefits from WellCare?
Benefits for WellCare’s Medicare Advantage plans can be attractive because many include some coverage for vision, dental and transportation to care. Drugs delivered via mail is an option, but there is limited telehealth, probably because government reimbursement for it is low or non-existent.
The company also offers something that many other insurance providers don’t — flexible coverage that you can use to pay for out-of-network coverage as well as dental, hearing or other healthcare for which it otherwise offers no coverage.
This benefit comes in the form of a credit card loaded with a predetermined spending amount that ranges from $200 to $2,500, depending on where you live and what your circumstances are. You use the card to pay for what you need.5
Flexible Coverage Offered
This benefit comes in the form of a credit card loaded with a predetermined spending amount that ranges from $200 to $2,500 and can be used to pay for out-of-network coverage as well as dental, hearing, or other healthcare for which it otherwise offers no coverage.
How Do You Enroll in Coverage with WellCare?
You can enroll in multiple ways. When companies such as WellCare first launched, the insurance options for participants in government programs had limits. Many states either managed all the coverage themselves or hired a single company.
Today, numerous companies specialize in managing government insurance, so participants must learn about the options and pick the company that best meets their needs.
WellCare encourages potential customers to call (877) 823-8267 (TTY 711), 8AM to 8PM, seven days a week.
At the WellCare website, you can enter your ZIP code and shop in whatever state and area you live.
If you’d like to have someone call you, fill out this form.
If you are particularly interested in talking to someone in your neighborhood, fill out this form, and a local representative will call you.
How Do You File Claims with WellCare?
Filing claims with WellCare is usually the responsibility of your healthcare providers. They file with WellCare and WellCare sends the claim to Medicare and Medicaid.
If either WellCare or the government agency providing the coverage denies your claim, WellCare has procedures in every state to help you appeal.
How Do Consumers and Financial Ratings Services Feel about WellCare?
The volume of debt affects WellCare and its parent company Centene’s financial ratings.
Moody’s and Fitch: Shortly after Centene purchased WellCare, Moody’s Investor’s Service upgraded WellCare’s senior unsecured debt from Ba1 to Ba2. A year later, Fitch rated Centene’s debt BBB. Neither of these ratings are impressive — conservative investors might avoid investments in companies with ratings like these because they consider them speculative. But customers shouldn’t worry that these companies won’t pay their claims because state and federal governments are the ultimate guarantors.
Medicare: In 2020, WellCare got 4 out of 5 stars from the Centers for Medicare and Medicaid Services (CMS) for its Florida Medicare Advantage plans operations. A 4-star rating is considered “above average.”
For anyone in need of guidance choosing a Medicare Advantage plan, here are links to information about plans in almost every state.
- A large number of Medicare Advantage plans are available. Learn what plans are available in your area.
- Consider what WellCare offers and whether its plans meet your needs.
- Examine the list of healthcare providers available to you if you choose a WellCare plan and decide whether you will be satisfied.
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.