Wellcare is a Medicare insurance company, not Medicare itself
Wellcare is a private insurance company that offers Medicare plans. It is not the government Medicare program — it is one of many insurers you can choose from if you are on Medicare. Wellcare sells Medicare Advantage plans (Part C) and Medicare Supplement plans (Medigap) in certain states and counties.
When you turn 65 or become may be able to access for Medicare, you choose whether to stay with Original Medicare (run by the federal government) or switch to a private plan like Wellcare's. If you pick Wellcare, the company becomes your insurer, but Medicare still covers your care — Wellcare just handles the paperwork and payment.
Key Takeaways
- Wellcare is a private insurance company offering Medicare Advantage and Medigap plans in select states, not a government program.
- Medicare Advantage plans through Wellcare bundle hospital, doctor, and prescription drug coverage, often with lower monthly premiums than Original Medicare plus a supplement.
- Wellcare's service area varies by state and county, so you must check whether plans are offered where you live.
- You can only switch to or from Wellcare during Medicare's open enrollment period (October 15 to December 7 each year) or if you have a may have access to life event.
The two types of Wellcare Medicare plans
Wellcare offers Medicare Advantage plans, which combine hospital insurance (Part A), doctor visits (Part B), and usually prescription drug coverage (Part D) into one plan. You pay a monthly premium to Wellcare, a copay when you see a doctor or fill a prescription, and sometimes a yearly deductible. Most Wellcare Advantage plans have a network of doctors and hospitals you must use, except in emergencies.
Wellcare also sells Medigap plans (also called Medicare Supplement plans), which work alongside Original Medicare. You keep your Original Medicare coverage and pay Wellcare a separate monthly premium for a Medigap plan that covers some of the costs Medicare does not — like copays, coinsurance, and deductibles. Medigap plans do not include prescription drug coverage; you buy that separately through Medicare Part D.
The type of plan you choose depends on your health needs, budget, and whether you prefer lower monthly costs (Advantage) or more flexibility in choosing doctors (Medigap with Original Medicare).
What Wellcare Medicare Advantage plans typically include
Most Wellcare Medicare Advantage plans cover doctor visits, hospital stays, and prescription drugs in one package. Many also offer extra benefits that Original Medicare does not — such as dental, vision, hearing, or fitness programs. These extras vary by plan and location, so you need to check what your local Wellcare plans offer.
In a Wellcare Advantage plan, you usually choose a primary care doctor from Wellcare's network. That doctor coordinates your care and gives referrals to specialists. If you see a doctor outside the network (except in emergencies), you may pay more or the plan may not cover the visit at all. This is different from Original Medicare, where you can see any doctor who accepts Medicare.
Wellcare Advantage plans have an out-of-pocket maximum — a yearly limit on what you pay for covered services. Once you reach that limit, Wellcare covers the rest of your care for the rest of the year. This protects you from very high medical bills, something Original Medicare does not do.
Where Wellcare Medicare plans are available
Wellcare does not offer plans in every state or every county. Coverage areas change from year to year. Before you choose Wellcare, you must check whether the company offers plans in your zip code.
You can search for Wellcare plans on Medicare.gov by entering your zip code. The site will show you all Medicare plans available where you live, including Wellcare options. You can also call Wellcare directly at 1-855-835-5267 (TTY 711) to ask which plans serve your area, or contact your local Area Agency on Aging for help.
How to switch to or from Wellcare
You can change to a Wellcare plan or leave one during Medicare's Annual Enrollment Period, which runs from October 15 to December 7 each year. Changes take effect on January 1. This is the main window when you can switch plans without penalty.
If you have a may have access to life event — such as moving out of your plan's service area, losing other health coverage, or getting married — you may be able to switch plans outside the enrollment period. You usually have 60 days from the event to make the change. Contact Wellcare or Medicare to report the event and ask whether you can switch.
When you switch away from Wellcare, your coverage ends on December 31 and your new plan begins on January 1 (if you switched during the annual period). If you switch due to a may have access to event, the timing depends on when you report it.
Costs: premiums, copays, and deductibles
Wellcare Medicare Advantage plans have a monthly premium, which varies by plan and location. Some Wellcare Advantage plans have a $0 premium, meaning you pay nothing monthly — you only pay when you use care. Others charge $50 to $200 or more per month, depending on the coverage level and extras included.
When you use care, you pay copays (a set amount per visit) or coinsurance (a percentage of the cost). A routine doctor visit might cost $10 to $50 in copays, depending on your plan. Prescription drugs have their own copays, which are often lower for generic drugs and higher for brand-name ones.
Wellcare Medigap plans have a monthly premium but no copays or deductibles — the plan covers the costs that Original Medicare does not. Medigap premiums vary widely by plan type and location, typically ranging from $100 to $300 or more per month. You pay this premium to Wellcare in addition to your Original Medicare Part B premium.
How Wellcare compares to Original Medicare and other insurers
Original Medicare is run by the federal government and covers any doctor or hospital that accepts Medicare nationwide. You have no network limits and no out-of-pocket maximum. However, you pay a Part B premium, and Medicare covers only 80% of most services — you pay the other 20%. Many people add a Medigap plan to cover that gap.
Wellcare Advantage plans often have lower monthly premiums than Original Medicare plus Medigap, and they include prescription drug coverage. The trade-off is that you must use Wellcare's network (except emergencies) and you have an out-of-pocket maximum you must reach before full coverage kicks in.
Other major Medicare Advantage insurers include UnitedHealthcare, Humana, Aetna, and Cigna. Each company offers different plans, networks, and extra benefits in different areas. Comparing plans on Medicare.gov shows you the premiums, copays, and coverage for all insurers in your zip code, so you can see how Wellcare stacks up against competitors.
Frequently Asked Questions
Can I use my Wellcare plan if I travel or move?
Wellcare Advantage plans are usually limited to a specific service area. If you travel, you can use emergency services anywhere in the United States. For routine care outside your service area, you may have to pay out of pocket or wait until you return home. If you move permanently out of your plan's service area, you can switch plans outside the annual enrollment period.
Does Wellcare cover prescription drugs?
Most Wellcare Medicare Advantage plans include prescription drug coverage (Part D). Wellcare Medigap plans do not include drug coverage — you must sign up for a separate Part D plan through Medicare. Check your specific Wellcare plan documents to see which drugs are covered and what your copays are.
What happens if I need a specialist?
In a Wellcare Advantage plan, you usually need a referral from your primary care doctor to see a specialist. The specialist must be in Wellcare's network, or you may pay more. In a Wellcare Medigap plan with Original Medicare, you can see any specialist who accepts Medicare without a referral.
Can I switch back to Original Medicare if I do not like Wellcare?
Yes, you can switch to Original Medicare during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event. Once you switch, you may also want to buy a Medigap plan to cover costs that Original Medicare does not. There is no penalty for leaving Wellcare.
How do I contact Wellcare if I have questions about my plan?
You can call Wellcare at 1-855-835-5267 (TTY 711) to ask about coverage, find doctors in your network, or report a problem. Your Wellcare member card also lists a customer service number. You can also visit Wellcare's website or contact Medicare at 1-800-MEDICARE for help comparing or switching plans.