Wellcare Medicare Advantage pros and cons
Wellcare ’ second offerings have upsides and downsides :
- ship’s company strength : In 2020, Centene completed its skill of Wellcare, and the compound entities boosted their presence in the Medicare Advantage market — moving from 1.24 % in 2020 to 4.14 % of the grocery store in 2021 [ 3 ] .
- excess benefits : Some Wellcare plans include the Flex Card, which comes preloaded with extra funds members can use on alveolar consonant, imagination and hearing benefits once they ’ ve exhausted their plan coverage .
- extra benefits for the chronically ill : Some plans include special supplementary benefits for the chronically ill, including food, utility and worry concierge benefits .
- part B premium coverage : Some plans include a Giveback benefit that refunds some or all of your Medicare Part B agio .
- Lower star ratings : For 2022, Wellcare ’ second average star rat from Medicare is 3.6 stars ( out of 5 stars ), compared with an overall average among all Medicare Advantage plans of 4.37 stars. Wellcare ’ south contracts besides score ill on respective individual factors, from the percentage of plan members who get a influenza shooting to how easy it is for members to get needed care .
- Member discontented : When it comes to member satisfaction, J.D. Power found that Centene ( which acquired Wellcare in early on 2020 ) came in concluding out of the nine Medicare Advantage companies ranked .
- limited state coverage : Wellcare ’ randomness footprint has grown by several states in 2022 but even lags behind several other providers. Wellcare offers Medicare Advantage plans in 36 states and Special Needs Plans, or SNPs, in 33 states .
Available Wellcare Medicare Advantage plans
Wellcare offers respective kinds of Medicare Advantage plans, and they vary in social organization, costs and benefits. In general, Wellcare offers Medicare Advantage Prescription Drug Plans, or MAPDs, deoxyadenosine monophosphate well as stand-alone Prescription Drug Plans and Medicare Advantage Plans without drug coverage. design offerings include the follow types :
A health alimony organization, or HMO, broadly requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor of the church in order to see a specialist, and out-of-network benefits are normally very circumscribed .
HMO point of service, or POS, plans are HMO plans that allow members to get some out-of-network services, but you ’ ll pay more for those services .
Preferred supplier organization, or PPO, plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don ’ t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor .
Wellcare ’ sulfur private fee-for-service, or PFFS, plans allow you to see any Medicare-approved supplier who accepts your WellCare plan. You won ’ deoxythymidine monophosphate have to pick a primary coil repair, and you won ’ t need a referral to see a specialist .
particular needs plans, or SNPs, qualify membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. Wellcare offers two types of single nucleotide polymorphism :
- chronic Condition SNP : Designed to meet the needs of members living with certain chronic conditions, such as diabetes, congestive affection failure and cardiovascular disorder .
- Dual-Eligible SNP : For people who are entitled to Medicare and who besides qualify for aid from a state Medicaid program .
Available Part D prescription drug plans
While many of Wellcare ’ randomness Medicare Advantage plans include Part D drug coverage, the company besides sells stand-alone Part D prescription drug plans. These plans, which are meant to accompany Medicare Part A and Medicare Part B, do n’t provide medical coverage. Wellcare has reduced its stand-alone Medicare prescription drug plan offerings from six to three for 2022 [ 4 ] :
- Wellcare Value Script : median premium of $ 11.85 ; annual drug deductible of $ 480 .
- Wellcare Classic : median bounty of $ 30.82 ; annual drug deductible of $ 480 .
- Wellcare Medicare Rx Value Plus : average premium of $ 68.70. These plans all offer $ 0-annual drug deductibles .
The specifics of premiums, covered drugs, cost tiers and pharmacies differ by plan and express. You can enter information about your preferable drugstore and the prescription drugs you take on Wellcare ’ s web site to compare what each plan covers and what you would pay out of pocket each calendar month.
Wellcare Medicare Advantage offers most members access to dental, vision and hearing coverage, unlike Original Medicare. Many of its plans offer other benefits, equally well. here are a few standouts :
- Flex Card : Depending on your design and service area, some members may have access to a Visa debit card preloaded with between $ 200 and $ 2,500 that they can use to help pay for dental, vision or hear needs beyond plan coverage .
- nonprescription profit : Some plan members may get an allowance they can put toward over-the-counter items like cough and cold meds, first-aid supplies, vitamins and pain relievers .
- seaworthiness benefits : Some plans may cover the monetary value of an annual membership at a participating health golf club or fitness kernel .
- meal delivery : Some plans include free meal rescue for a specific issue of days with no copay .
- Telehealth : many plans cover telehealth video visits with no copay .
Wellcare members can contact their plan ’ sulfur customer service in the be ways :
- Send a doubt through a Contact shape .
- Call 800-960-2530 with general questions .
- Call the member number on your Wellcare poster .
- Visit your Wellcare state page ( search “ Wellcare ” and your state ) and choice Contact Us. This page contains earphone numbers for current and prospective Medicare members, american samoa well as a Nurse Advice Line and Behavioral Health Crisis Line, depending on the state .
Wellcare service area
Wellcare offers Medicare Advantage plans in 36 states, and Medicare prescription drug plans in all 50 states and Washington, D.C. In full, Centene offers Medicare Advantage plans in 1,575 counties [ 5 ], which is about precisely half of the counties in the U.S. Centene is tied with a few other companies as the seventh-largest health insurance company in the country, and it is the fifth largest provider among for-profit health plans [ 6 ]. About 1.1 million Medicare beneficiaries are enrolled in a Centene Medicare Advantage design, and the company added 773,000 new members for the 2021 plan year — both due to the learning of Wellcare and closely 200,000 newly enrollees.
Costs for Medicare Advantage plans will depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan ’ south agio. For 2022, Wellcare Medicare Advantage premiums range from $ 0 to $ 286 a month. Of Wellcare ’ randomness HMO, PPO, and PFFS plans, about seven out of 10 offer a $ 0-premium [ 7 ]. limited Needs Plans have premiums ranging from $ 0 to $ 40.70. lone about 2.3 % of Wellcare ’ s Special Needs Plans offer $ 0 premiums [ 8 ]. even as a Medicare Advantage user, you ’ ll silent be responsible for paying your Medicare Part B premium, which is at least $ 170.10 in 2022. ( Most people pay this standard total, but if your income is above a certain doorsill, you ’ ll pay up more. ) early out-of-pocket costs to consider include :
- Whether the plan covers any separate of your monthly Medicare Part B premium .
- The plan ’ s annual deductibles and any other deductibles, such as a drug deductible .
- Copayments and/or coinsurance for each visit or service. For case, there may be a $ 10 copay for seeing your primary sophisticate and a $ 45 copay for seeing a specialist .
- The plan ’ s in-network and out-of-network out-of-pocket maximums .
- Whether your aesculapian providers are in-network or out-of-network, and how much you may go out-of-network for worry .
- Whether you require extra benefits, and if the plan charges for them .
To get a sense of costs, habit Medicare ’ randomness plan finding tool to compare information among available plans in your area. You can select by indemnity carrier to see entirely Wellcare plans, or compare across carriers. You can besides shop directly from Wellcare ’ s web site by entering your ZIP code, and you ’ ll be able to compare the plans available.
Medicare star ratings
average star Rating : 3.6 The Centers for Medicare and Medicaid Services maintains its own database of star ratings on every Medicare Advantage and freestanding Medicare Part D plan, ranging from best ( 5 stars ) to worst ( 1 star ). The representation bases these ratings on plans ’ quality of wish and measurements of customer gratification, and ratings may change from year to year. Based on the most holocene year of data, Wellcare ’ second 2022 Medicare Advantage plans ( Part C ) get an average rat of 3.4, and the company ’ s prescription drug plans ( Part D ) get an average score of 3.7. The overall average score for Wellcare ’ randomness plans is 3.6 [ 9 ]. For comparison, the average ace fink for plans from all providers was 4.37 [ 10 ]. Of Wellcare ’ s contracts, the majority are rated 3.5 or 4.0. only 26 % of Wellcare ’ sulfur Medicare Advantage members who are in rated contracts are in contracts with 4 stars or more in 2021 [ 11 ]. only three Medicare Advantage contracts received 4.5 stars, and alone one received 5 stars. There were besides 27 Wellcare contracts that were besides modern to be measured and 15 more with insufficient data available for scoring by the Centers for Medicare and Medicaid Services.
Read more: Debt Restructuring Definition
Where did Wellcare outperform?
To get an overall leading rat, the CMS ranks contracts on 40 different plan factors. ( You can find definitions for each of these factors in the CMS Star Ratings Technical Notes. ) Wellcare didn ’ t surpass in many categories, but here are the areas where Wellcare plans earned an average score of 4.5 stars ( out of 5 ) and above :
- Reviewing appeals decisions .
- Health plan : Call center — extraneous linguistic process interpreter and TTY handiness .
- drug plan : Call center — extraneous language interpreter and TTY handiness .
- Medication Therapy Management course of study completion rate for Comprehensive Medication Review .
Where did WellCare struggle?
Wellcare contracts struggled in several categories. ( You can find definitions for each of these factors in the CMS Star Ratings Technical Notes. ) here ’ sulfur where they averaged a sub-3.0 star score :
- annual influenza vaccine .
- Improving bladder control .
- Rating of health plan .
- Monitoring physical natural process .
- Rheumatoid arthritis management .
- Reducing the risk of falling .
- Medication reconciliation post-discharge .
- Rating of health care timbre .
You can find a design ’ s fink with the Medicare design finding instrument.
There are a few companies that weigh in on health plans or on the strength of the company in question, and we ’ ve included two here :
J.D. Power Ranking: 9th out of 9
In its 2021 U.S. Medicare Advantage Study — the seventh it ‘s done indeed far — J.D. Power measured member satisfaction with Medicare Advantage plans based on six factors : coverage and benefits, supplier choice, cost, customer avail, information and communication and charge and payment. On these measures, Centene ( which acquired Wellcare ) scored 769 points out of 1,000 and came in ninth out of the peak nine Medicare Advantage providers [ 12 ] .
NCQA Score Range: 2.5 to 3.5 out of 5
The National Committee for Quality Assurance rates health indemnity plans on a 5-point scale ( with 5 being best ) based on clinical quality, penis gratification and results from the NCQA Accreditation Survey. The ratings highlight the results of care and what patients say about their care. In September 2021, the NCQA ranked Wellcare plans between 2.5 and 3.5 stars, with nine of the 13 rated plans scoring 3.0 stars. The two best scoring plans were Wellcare of California and Wellcare of Florida. Wellcare of South Carolina and Wellcare Health Plans of New Jersey scored the lowest among the rated Wellcare plans [ 13 ].
See how Medicare Advantage competitors stack up to Wellcare .
|Compare Medicare Advantage providers|
|party||percentage in a 4-star plan or higher||Service area||median Medicare headliner evaluation ( 2022 )|
|Aetna||87 % .||46 states and Washington, D.C .||3.8 .|
|hymn||72 % .||24 states and Puerto Rico .||3.9 .|
|Blue Cross Blue Shield||59 % .||44 states .||4.1 .|
|Cigna||87 % .||26 states and Washington, D.C .||4.2 .|
|Humana||93 % .||47 states and Puerto Rico .||4.1 .|
|Kaiser Permanente||100 % .||8 states and Washington, D.C .||5 .|
|UnitedHealthcare||76 % .||50 states, Washington, D.C., American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands .||4.2 .|
|Wellcare||26 % .||36 states .||3.6 .|
Find the right Medicare Advantage plan
It ’ sulfur crucial to do your inquiry before selecting a Medicare Advantage plan for yourself. here are some questions to consider ask :
- What are the plan ’ s costs ? Do you understand what the plan ’ randomness agio, deductibles, copays and/or coinsurance will be ? Can you afford them ?
- Is your doctor of the church in-network ? If you have a choose aesculapian provider or providers, make sure they participate in the plan ’ mho network .
- Are your prescriptions covered ? If you ’ re on medicine, it ’ south crucial to understand how the plan covers it. What tier are your prescription drug drugs on, and are there any coverage rules that apply to them ?
- Is there dental coverage ? Does the plan offer routine coverage for vision, alveolar consonant and hearing needs ?
- Are there supernumerary ? Does the plan offer any excess benefits, such as fitness memberships, transportation benefits or meal delivery ?
If you have extra questions about Medicare, visit Medicare.gov or call 800-MEDICARE ( 800-633-4227, TTY 877-486-2048 ).