Medicare Plans Offered by WellCare8 minute read
8 minute read|
Updated for January, 2019
Medicare Advantage plans are provided by a variety of private insurance companies, one of which is WellCare. We’ll discuss the plans and benefits they offer, including other information, in the following article.
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There are two ways to get Medicare when you turn 65, though you may also qualify for coverage if you’re under the age of 65 and have a specific medical condition, such as end-stage renal disease.
The first is referred to as Original Medicare, which is obtained through the federal government. This form of Medicare consists of Part A, which is Hospital Insurance, and Part B, also known as Medical Insurance.
The second way to get Medicare is through a private insurance company. This option is typically called Medicare Advantage or Medicare Part C, and it’s sometimes preferred for two primary reasons. In addition to providing all of the same coverages as Original Medicare parts A and B, many of these plans also provide coverage related to dental, vision, hearing, and prescription drugs—whereas Original Medicare does not.
WellCare’s Medicare Advantage Plans
WellCare currently serves approximately 5.5 million members nationwide while offering four basic types of Medicare Advantage Plans:
WellCare Health Maintenance Organization (HMO) Plans
If you choose a WellCare Medicare plan that is an HMO, you will be required to name a primary care physician (PCP). Your PCP is responsible for overseeing all of your medical needs, which includes referring you to another healthcare provider in the network (such as a specialist) if he or she deems it necessary. One of the primary benefits of this type of plan is that it often tends to have lower premiums, copays, and coinsurance, making it a more affordable option.
WellCare Point of Service (POS) Plans
A POS plan is actually a type of HMO in that it also operates by providing you care via a network of healthcare providers. However, the one difference is that with a POS plan you’re also able to see medical professionals outside the network when the plan authorizes it. That said, the plan does encourage you to choose in-network healthcare providers whenever possible.
WellCare Preferred Provider Organization (PPO) Plans
WellCare also offers a few PPO Medicare plans to those residing in certain counties in New York, Georgi, Florida, and South Carolina. PPOs enable you to see any healthcare provider you’d like, as long as he or she is in the plan’s network. This type of plan typically has higher premiums, copay, and coinsurance, but some people prefer it because it offers more flexibility when choosing a healthcare provider.
WellCare Special Needs Plans (SNP)
An SNP is typically offered to those with chronic health issues or those who qualify for insurance coverage through both Medicare and Medicaid. Availability varies by location.
WellCare’s Prescription Delivery Options
With WellCare prescription drug coverage, you can often elect to receive your medication by mail. This service is provided by CVS Caremark and you can sign up online, by printing and completing a Mail Service Order Form and mailing it in, or by calling FastStart at (800) 875-0867.
If you choose to sign up by phone, you will need your WellCare benefit ID number, your doctor’s name and phone number, and your payment information. Sign up with the mail-in form and you’ll need all of this information as well as your complete mailing address, any allergies or other health conditions you may have, and a 90-day original prescription for the medication you want.
If the medication is approved for mail delivery, CVS Caremark will contact your doctor and request a 90-day prescription (if one was not submitted). Once this is received, the script will be filled and mailed to you at no charge if you choose regular delivery. If you need it quicker, you can always pay for overnight or second-day delivery.
Refills can also be processed online, by phone, or via mail.
If you purchase a Medicare plan from WellCare, you also have the benefit of using its Nurse Advice Line.
Additional WellCare Medicare Plan Benefits
If you purchase a Medicare plan from WellCare, you also have the benefit of using its Nurse Advice Line that’s available 24 hours a day, 7 days a week. If you have questions regarding a specific medical condition, you can call (800) 581-9952 (TTY: 711) for advice.
WellCare also offers a Medication Therapy Management Program that was designed to help reduce your drug-related risks, increase your prescription awareness, and support healthy prescription drug habits. With this program, you get a comprehensive medication review, which is a one-on-one discussion with a pharmacist to discuss all of your prescription medications, over-the-counter medicines, herbal treatments, and dietary supplements to ensure they all work well together.
You also receive a targeted medication review, which consists of WellCare contacting your doctor to talk about medications that may be more effective or safer for you to take.
To qualify, you must be on at least eight maintenance drugs—they all must be covered by Medicare Part D—and reach yearly prescription drug costs of $4,044 paid by both you and your prescription drug plan. You must also have at least three of the following health conditions:
- Cardiovascular disorder (high blood pressure, high cholesterol, coronary artery disease)
- Chronic heart failure
- Chronic obstructive pulmonary disease (commonly referred to as COPD)
Finding the Best WellCare Medicare Plan for You
To find the WellCare Medicare options available to you, simply visit WellCare’s website and select state reside in. Next, pick the type of plan you want (whether Medicare or a Prescription Drug Plan) and enter your zip code.
You’ll then see a list of the options available to you. You can click on each one to be taken to a page where you can download the documents related to that specific plan. For instance, if you download its Summary of Benefits, you are provided more information about the plan’s premium, deductible, copays, and your maximum out-of-pocket responsibility.
The Summary of Benefits also shares what is covered under that plan in relation to preventive care, emergency care, diagnostic services, mental health, physical therapy, and more. If the plan offers coverage for dental, vision, and/or hearing, that information is provided here as well.
WellCare’s website also lets you compare the WellCare Medicare plans available in your area. It’s all presented in an easy-to-read chart that helps you understand how the plans are similar to and different from one another.
Plus, each WellCare plan is shown with a Medicare star rating, which is based on 53 criteria Medicare uses to evaluate all individual plans on a yearly basis. This rating is also based on both quality of the plan and its performance, which gives you an idea of how it compares to all other Medicare plans on the market.
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