Wellcare Medicare Advantage Reviews

Wellcare Medicare Advantage plans offer competitive benefits like Part B premium Givebacks but often fall short in ratings and member satisfaction compared to other major providers.
By . Last update: June 11, 2024

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Wellcare Medicare Advantage Reviews
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Wellcare, owned by Centene Corporation, provides a variety of Medicare Advantage (Part C) plans that deliver comprehensive healthcare coverage at competitive prices. While Wellcare’s plans offer attractive perks, such as Giveback plans that cover part or all of your Part B premium, they often struggle to keep up with other companies’ CMS star ratings.[1]

In this review, we’ll look into some of Wellcare’s Medicare Advantage plans, examining their coverage options, costs, and customer feedback.

Table of Contents

Member Reviews for Wellcare

The following Wellcare reviews have been left by our members.

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PROS

  • Competitive Pricing: Wellcare plans are often more affordable compared to other providers.
  • Giveback Plans: Some plans cover part or all of the Part B premium.
  • Additional Benefits: Plans may include dental, vision, hearing, and fitness memberships.
  • Telehealth Services: Access to telehealth services is often included.
  • Spendables Card: Some plans offer a preloaded card for over-the-counter products or dental care costs.

CONS

  • Member Satisfaction: Customer satisfaction ratings are often below those of other major providers.
  • Lower Star Ratings: Wellcare’s most recent average star rating from Medicare is 3.02 stars, compared to an overall average of 4 stars across all Medicare Advantage plans.
  • Network Limitations: The network of doctors and hospitals may be more limited compared to competitors.
  • Service Area Restrictions: Wellcare offers Medicare Advantage plans in 37 states, which may limit availability.
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How Do Wellcare Medicare Advantage Plans Work?

Wellcare Medicare Advantage plan members receive all of their Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) benefits through their plan. This includes preventive care, screenings, vaccinations, doctor and specialist visits, and inpatient care.

All Wellcare Medicare Advantage plans include coverage for:

  • Inpatient hospital admissions.
  • Doctor and specialist care.
  • Preventive care, screenings, and vaccinations.
  • Diagnostic services, lab work, X-rays and other imaging.
  • Outpatient services.
  • Ambulance transportation for emergencies.
  • Durable medical supplies and equipment.

Medicare rules mandate that all Medicare Part C plans offer coverage and benefits that match or exceed those of Original Medicare. However, Wellcare sets its own out-of-pocket costs.

Additional benefits like routine dental, vision, hearing, and wellness programs are included in some Wellcare plans. Original Medicare does not typically cover these services.

By enrolling in a Wellcare Medicare Advantage plan, many beneficiaries enjoy the convenience of having all their healthcare needs managed under one plan, often with lower out-of-pocket costs and additional perks tailored to their health and lifestyle.

However, it's important to understand that lower costs are not guaranteed. Costs are largely based on the specific plan and usage of healthcare services. Also, depending on the Wellcare plan chosen, there may be access restrictions, including referrals and prior authorization, which do not exist in Original Medicare.

Extra Benefits from Wellcare

Most Wellcare Medicare Advantage plans include benefits that extend beyond basic medical coverage. Common additional benefits are:

  • Spendables Card: Preloaded funds for over-the-counter products and dental care costs.
  • Part B Giveback: Covers some or all of your Part B monthly premium.
  • Dental, Vision, and Hearing: Allowances for routine check-ups and necessary procedures.
  • Over-the-Counter Allowances: Monthly or quarterly allowances for OTC medications and health-related items.
  • Meal Delivery Services: Healthy meal deliveries post-hospital discharge.
  • Fitness Programs: Access to fitness centers and wellness programs.

These benefits aim to enhance overall health and wellbeing for members​​ .

What Types of Plans Does Wellcare Offer?

Not all Wellcare plans are the same. And, Wellcare may not offer all plan types where you live, so it pays to explore using our Medicare Advantage Plan Finder tool. Here are the plan types Wellcare offers:[6]

Health maintenance organization (HMO) plans require that you use a specific network of doctors and hospitals. Also, with a Wellcare HMO plan you may need a referral from your primary care doctor in order to see a specialist. Out-of-network benefits are usually very limited. However, in an emergency you are not limited to care from your local hospital of emergency room.

Medicare preferred provider organization (PPO) plans provide the most freedom, allowing you to see any provider that accepts the insurance. With a PPO plan, you generally do not need to choose a primary care doctor, and you don’t need referrals to see specialists. And you can seek out-of-network care, although it may cost more than seeing an in-network doctor.

HMO point-of-service plans are HMO plans that allow members to get some out-of-network services, but you’ll pay more for those services.

Wellcare’s private fee-for-service (PFFS) plans allow you to see any Medicare-approved provider who accepts your Wellcare plan. With PFFS plans, you don’t have to pick a primary care doctor and won’t need a referral to see a specialist.

NOTE: Wellcare may also offer Medicare Advantage Special Needs Plans (SNPs). Due to the highly specialized nature of D-SNP (dual eligible), C-SNP (chronic condition), and I-SNP (institutional) insurance plans, we review them separately.

How Much Do Wellcare Plans Cost?

The cost of a Wellcare plan will vary depending on the specific plan chosen, your location, usage of healthcare services, and the plan's out-of-pocket costs. We detail out-of-pocket costs on all Wellcare Medicare Advantage Plans in our plan finder.

Typically, Wellcare charges a monthly premium, which can vary depending on the coverage level and additional benefits included. You must also keep paying your Part B premium. Additionally, if you are a high-income earner, Medicare may apply a monthly Income Related Monthly Adjustment Amount (IRMAA).[5]

Wellcare’s monthly premiums are highly dependent on where you live. For instance, the average cost of a Medicare Advantage plan from Wellcare in California is $0.00 per month, but in New York the average cost is $30.25 per month. These averages do not include Special Needs Plans.

Wellcare's Premiums vs. Competitors

The following list shows Wellcare's nationwide average monthly premium (excluding Special Needs Plans) vs. several competitors.

Wellcare
$13.97
Aetna
$5.51
Cigna
$42.17
Kaiser
$10.11
AARP
$22.97

There also may be copayments or coinsurance for healthcare services, such as doctor visits or hospital stays. The costs in each Wellcare plan we evaluated varied based on the level of coverage and the type of services received.

Be aware that some plans have $0 premiums or low copayments for specific services, whereas others could feature higher premiums but reduced out-of-pocket expenses. It’s essential to thoroughly examine the costs and coverage details of each plan option so you can find the one that best suits your budget and healthcare needs.[7]

We analyzed the following popular Wellcare plans to give you an idea of what members pay to use healthcare services. This is just a sample, use our Medicare Advantage Plan Finder to see plans and costs where you live.

Important costs for plan ID H2775-105-0 reviewed in Bronx County, NY.
  • Monthly premium: $110
  • Out-of-pocket max: $3,400
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $5.00 copay, $0 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None
Important costs for plan ID H4868-016-0 reviewed in Bronx County, NY.
  • Monthly premium: $32
  • Out-of-pocket max: $6,700
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $19.00 copay, $540 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None
Important costs for plan ID H5599-002-0 reviewed in Bronx County, NY.
  • Monthly premium: $28
  • Out-of-pocket max: $7,550
  • Primary Care: $$0
  • Specialist: $$0
  • Tier 1 Prescriptions: $19.00 copay, $430 deductible
  • Urgent Care: $$0
  • Emergency Room: $$0
  • Ground Ambulance: $$0
  • Inpatient Care:
  • Extra Benefits: None

Is Wellcare a Good Medicare Advantage Plan?

Wellcare’s Medicare Advantage plans have received mixed reviews from various consumer intelligence and review websites. They offer several benefits but also face significant challenges in terms of quality and member satisfaction.

Better Business Bureau (BBB)

The Better Business Bureau (BBB) rates Wellcare Health Plans, Inc. with a C, which suggests there are significant areas for improvement in customer satisfaction and business practices. The company is not accredited by the BBB and has received an average of 1 out of 5 stars based on customer reviews. Complaints often pertain to issues with service or repair, with two complaints closed in the past three years​​​​.

J.D. Power Ranking

In its 2023 U.S. Medicare Advantage Study, J.D. Power assessed member satisfaction with Medicare Advantage plans across eight factors, including trust and problem resolution. The study covered the five largest Medicare markets. Centene, which owns Wellcare, ranked as follows:[2]

  • California: 7th out of 7
  • Florida: 6th out of 6
  • New York: 8th out of 8
  • Texas: 6th out of 6

These rankings indicate significant room for improvement in member satisfaction, particularly in trust, problem resolution, and overall service quality.[2]

Consumer Review Websites

Wellcare's ratings on consumer review websites also reflect a range of experiences. Customers have reported frustrations with service quality, particularly around care coordination and customer service, aligning with its lower-than-average member satisfaction scores from Medicare. For example, on ConsumerAffairs, Wellcare has received a range of reviews, often highlighting issues with timely approval of medical treatments and overall customer service.

National Committee for Quality Assurance (NCQA)

The NCQA awarded Wellcare a rating of 3.0 out of 5 stars in its 2023 evaluation. This rating is based on measures of clinical quality, member satisfaction, and efforts to improve healthcare quality. The score suggests that while Wellcare meets certain standards, there are areas needing improvement compared to higher-rated plans.[4]

AM Best Rating

For the most recent financial strength rating, AM Best, a leading credit rating agency, evaluates Wellcare’s parent company, Centene Corporation. As of the latest reports, Centene holds a rating of A (Excellent), suggesting a strong ability to meet ongoing insurance obligations​​. AM Best named Centene Corporation one of the top ten best global insurers.[3]

Overall Assessment

Wellcare's Medicare Advantage plans are suitable for those looking for competitive premiums and a variety of coverage options. However, potential enrollees should weigh these benefits against the reported drawbacks in service and member satisfaction. The diverse feedback from different sources underscores the importance of considering individual healthcare needs and preferences when selecting a plan.

 

Wellcare's Medicare Star Ratings

Wellcare's average 5-star rating: 3.02*
*Our calculation is weighted by enrollments in public plans, excluding Special Needs Plans, with CMS star ratings across 78 contracts covering 1,098,490 members.

If you want the government’s take on the quality of Wellcare’s Medicare Advantage plans, check out the Centers for Medicare and Medicaid Services' star ratings, which rank each plan from 1 (worst) to 5 (best) stars. The health agency assigns ratings based on quality of care and customer satisfaction measurements, and updates ratings every year.[9]

All Medicare Advantage plans are evaluated on CMS's health plan measures. Plans that include prescription drug coverage are also evaluated on drug plan measures. Based on the most recent year of data and weighted by enrollment, Wellcare’s 2024 Medicare Advantage plans get an average rating of 3.02 stars.[9] [11]

As of January 1, 2024, 0% of Wellcare members are enrolled in contracts with a Medicare star rating of 4 stars or higher.

You can view all plan ratings in your area with our Medicare Advantage Plan Finder tool.

Plan Availability

Wellcare's Medicare Advantage plans are accessible in 33 states, covering:

AL, AR, AZ, CA, CT, FL, GA, HI, IL, IN, KS, KY, LA, MA, ME, MI, MO, MS, NC, NE, NH, NJ, NY, OH, OK, OR, PA, RI, SC, TN, TX, VT, and WA.

Wellcare extends its coverage to 0 of the 3,140 counties across the U.S.[8]

Wellcare's Top Plans

Here's a list of Wellcare's most popular plans (by enrollments):[9][10]

Medicare Advantage Search and compare Medicare Advantage plans available in your area.

Find Plans in your area with your ZIP Code

Frequently Asked Questions

The following are the most frequently asked questions we found about Wellcare's Medicare Advantage plans:

Some Medicare Advantage plans offer a zero-dollar monthly premium because what Medicare pays the plan, plus your Medicare Part B premium, cover the full cost. For healthy people who want to keep their monthly costs low, these plans are an attractive option. But, just be aware that the premium is not the only cost. Plans also have copays or coinsurance you must pay when you use services. To learn more about free Medicare Advantage plans, read Why are Some Medicare Advantage Plans Free?

MA Plan Pros

  1. The maximum out-of-pocket cost is $7,550 a year
  2. Many plans cost $0 extra a month
  3. Most plans include drug coverage
  4. Many include basic hearing, dental, and vision benefits
  5. May include gym discounts (Silver Sneakers)

MA Plan Cons
  1. Can only switch during Open Enrollment
  2. Not easy to compare because plans are not standardized
  3. No nationwide coverage (plans don't travel with you)
  4. Most are HMO plans that require referrals to see a specialist
  5. Plans can change health and drug coverage each year

Learn more in this article.

Original Medicare is a Private Fee-for-Service (PFFS) health insurance system. Beneficiaries can use any healthcare provider that accepts Medicare. Most Medicare Advantage plans are a form of managed care health insurance, including HMOs and PPOs. As such, they have networks of doctors and hospitals that plan members use to receive care. With Original Medicare, the federal government pays about 80% of all Medicare-approved costs and the beneficiary pays the remaining 20% out-of-pocket. However, the 20% gap in coverage can be supplemented with a Medigap plan. With Medicare Advantage, members must pay all copays out-of-pocket until spending reaches the plan maximum, which can be up to $7,550. To learn more about how plans work, read How Does Medicare Advantage Work.

Researching your health plan options is important. Here are some key questions to consider before choosing a Medicare Advantage plan as well as additional companies to read about:

Key Questions

All plans potentially have monthly premiums, deductibles, copayments, and/or coinsurance, including plans from Wellcare. Are these costs within your budget?

  • Does the plan cover your prescriptions? Knowing how a plan covers them is important if you have regular prescriptions because costs and coverage vary widely from plan to plan.
  • Are your doctors in the plan’s network? If you have preferred providers, ensure they participate in the plan’s network.
  • Is routine dental, vision, and hearing covered? Traditional Medicare doesn’t cover these services. If you need it, be sure to explore plans that cover it.
  • What extras does the plan include? Plans may include many beneficial extras, like gym memberships (SilverSneakers), medical transportation, meal delivery, telehealth, and more.

If you have additional questions, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

About Wellcare

Headquartered in St. Louis, Missouri, Wellcare is a subsidiary of Centene Corporation and offers a range of Medicare Advantage plans. Their health insurance offerings include Medicare Advantage Plans (Medicare Part C), Medicare Part D Plans (prescription drug plans), and Medicaid coverage. Recently, Wellcare expanded its offerings for 2024, introducing new plans and benefits, including the Wellcare Spendables card, which provides funds for over-the-counter products and other costs.

You can enroll in a Wellcare plan during your Initial Enrollment Period (IEP) at age 65, the annual Open Enrollment Period (Oct 15 - Dec 7), or a Special Enrollment Period (SEP) based on special circumstances, such as moving or losing employer coverage.

Citations

MedicareWire uses trustworthy sources to inform its work, including government websites, government data, actuarial service data, consumer intelligence websites, and peer-reviewed studies. All content is fact-checked for accuracy, timeliness, and relevance. We used the following information sources in this review: