WellCare Offers Both Medicare and Medicaid Plans

WellCare is an insurance company that runs plans under both Medicare and Medicaid, so the answer depends on which program you are looking at. WellCare Medicare Advantage plans are for people 65 and older who have Original Medicare. WellCare Medicaid plans are for people under 65 (or over 65 in some states) who meet their state's income and asset limits for Medicaid. The two are separate programs with different rules, different costs, and different coverage — so you need to know which one you are considering.

This matters because the enrollment periods are different, the coverage is different, and the out-of-pocket costs work differently. If you are already on Medicare, you cannot switch to a WellCare Medicaid plan unless you also lose Medicare may be able to access. If you are on Medicaid and turn 65, your state may move you to Medicare automatically, or you may have to switch yourself.

Key Takeaways

  • WellCare Medicare Advantage plans are for people 65 and older with Original Medicare, and you can switch during the Annual Enrollment Period (October 15 to December 7 each year).
  • WellCare Medicaid plans are for people under 65 who meet your state's income limits, and enrollment rules vary by state and by whether you are explore for the first time or renewing.
  • You cannot hold both a WellCare Medicare Advantage plan and a WellCare Medicaid plan at the same time — Medicare takes priority once you turn 65.
  • WellCare operates in most states but not all, so availability depends on where you live and which program you are looking at.
  • Your state Medicaid office or Medicare.gov can tell you whether WellCare plans are available to you and what the enrollment important date are.

WellCare Medicare Advantage Plans: Who They Are For

WellCare Medicare Advantage (also called Medicare Part C) is an alternative to Original Medicare. You must already have Medicare Part A (hospital insurance) and Part B (medical insurance) to join a WellCare Medicare Advantage plan. These plans bundle hospital, medical, and usually prescription drug coverage into one plan, and they often include dental, vision, or hearing benefits that Original Medicare does not cover.

You can only join a WellCare Medicare Advantage plan during specific enrollment windows. The main window is the Annual Enrollment Period, which runs from October 15 to December 7 each year, and coverage starts January 1. If you just turned 65 or just became may be able to access for Medicare for another reason, you have a 7-day Initial Enrollment Period to join. If you lose other health coverage, you may have a 60-day Special Enrollment Period.

WellCare Medicare Advantage plans vary by state and by plan type. Some are Health Maintenance Organization (HMO) plans, which require you to use doctors in the plan's network and usually require a referral to see a specialist. Others are Preferred Provider Organization (PPO) plans, which let you see out-of-network doctors but charge more. You can compare plans and check whether WellCare operates in your area on Medicare.gov.

WellCare Medicaid Plans: Who They Are For

WellCare Medicaid plans are for people who meet their state's income and asset limits for Medicaid. Income limits vary widely by state — some states cover people earning up to 138% of the federal poverty level, others cover less. Asset limits (the total value of money and property you own) also vary by state, and some states have eliminated asset limits entirely.

Medicaid may be able to access categories include low-income adults, children, pregnant people, parents, people with disabilities, and people over 65 who do not yet have Medicare. If you are over 65 and have both Medicaid and Medicare, you are called "dual may be able to access," and your state may enroll you in a WellCare Medicaid plan that works alongside your Medicare coverage.

Enrollment in WellCare Medicaid plans depends on your state. Some states have continuous enrollment (you can explore any time), others have open enrollment periods, and some use a lottery system when funds run out. Your state Medicaid office can tell you the current enrollment rules and whether WellCare plans are available in your area.

The Difference in Coverage and Cost

WellCare Medicare Advantage plans have a monthly premium (usually $0 to $50, though this varies), a yearly deductible, and copays or coinsurance for doctor visits and hospital stays. You pay nothing for preventive care like annual checkups and screenings. Prescription drug coverage is included, with a separate deductible and copays for medications.

WellCare Medicaid plans have no monthly premium in most states. You may pay small copays for doctor visits and medications (usually $1 to $5), or you may pay nothing at all — this depends on your state and your income level. Medicaid covers a broader range of services than Medicare, including long-term care, dental, and vision in many states.

The key difference: Medicare Advantage is insurance you buy with your own money (or that Medicare pays for on your behalf). Medicaid is a joint federal and state program for people with low income, and the state pays most or all of the cost.

What Happens If You Have Both Medicare and Medicaid

If you are over 65 and have both Medicare and Medicaid, you are dual may be able to access. Your state may automatically enroll you in a WellCare dual-may be able to access plan, or you may need to choose one yourself. These plans coordinate coverage between the two programs — Medicare pays first, and Medicaid covers what Medicare does not.

If you are under 65 and on Medicaid, and you turn 65, you will become may be able to access for Medicare. Your state will usually notify you and may automatically enroll you in a Medicare plan. If you are in a WellCare Medicaid plan when this happens, you will need to switch to a WellCare Medicare plan or a different Medicare plan. You cannot stay on Medicaid alone once you are 65 (unless you are in a state that covers people over 65 under a special Medicaid category, which is rare).

How to learn about WellCare Is Available to You

WellCare operates in most states but not all. To check whether WellCare Medicare Advantage plans are available in your area, go to Medicare.gov, click "Find Care Providers," and enter your ZIP code. You can see all Medicare Advantage plans available to you, including WellCare plans, and compare their coverage and costs.

To check whether WellCare Medicaid plans are available, contact your state Medicaid office. You can find your state office at Medicaid.gov or by calling 1-800-MEDICARE. Your state office can tell you which managed care plans (including WellCare) are available, what the enrollment important date are, and whether you meet the income limits for your state.

If WellCare is not available in your area, your state Medicaid office or Medicare.gov can show you other plans that are. Many states have multiple managed care plans to choose from, so you will have other options.

Common Mistakes to Avoid

Do not assume that because WellCare offers both Medicare and Medicaid plans, you can switch between them freely. Once you are on Medicare, you stay on Medicare — you cannot drop it to go back to Medicaid unless you move to a state with different rules or your circumstances change dramatically. Medicaid is a backup program for people without Medicare, not an alternative to it.

Do not miss your enrollment important date. For Medicare Advantage, the Annual Enrollment Period is October 15 to December 7. If you miss it, you cannot join a plan until the next year, unless you have a may have access to life event (like losing other coverage or moving). For Medicaid, important date vary by state, so check with your state office.

Do not assume that a WellCare plan in one state is the same as a WellCare plan in another state. Coverage, costs, and network doctors are all different by state. If you move, you will need to check whether your current plan is available in your new state and whether you need to switch.

Frequently Asked Questions

Can I be on a WellCare Medicare plan and a WellCare Medicaid plan at the same time?

No, not as separate plans. If you are dual may be able to access (over 65 with both Medicare and Medicaid), you may be in a single WellCare dual-may be able to access plan that coordinates both programs. But you cannot hold a WellCare Medicare Advantage plan and a WellCare Medicaid plan as two separate plans.

If I switch to a WellCare Medicare Advantage plan, can I go back to Original Medicare?

Yes, during the Annual Enrollment Period (October 15 to December 7) or if you have a may have access to life event. You can switch back to Original Medicare or to a different Medicare Advantage plan. If you switch back to Original Medicare, you may need to sign up for a separate prescription drug plan (Part D).

Does WellCare Medicaid cover the same services as WellCare Medicare Advantage?

No. Medicaid covers more services in most states, including long-term care, dental, and vision. Medicare Advantage covers hospital, medical, and prescription drugs, plus some extra benefits like dental or vision, but not long-term care. Your state determines what WellCare Medicaid covers.

What if I do not know whether I have Medicare or Medicaid?

Check your insurance card — it will say "Medicare" or "Medicaid" at the top. If you have both, your card will say "Medicare" and you will have a separate Medicaid card. If you cannot find your card, call 1-800-MEDICARE (for Medicare) or your state Medicaid office (for Medicaid).

Can I switch WellCare plans during the year if I am not happy with mine?

For Medicare Advantage, you can only switch during the Annual Enrollment Period or if you have a may have access to life event. For Medicaid, it depends on your state — some allow switches any time, others only during open enrollment. Contact your state Medicaid office or WellCare directly to ask.