WellMed is a Medicare Advantage plan, not a Medicaid plan

WellMed offers Medicare Advantage plans (also called Part C plans) to people age 65 and older who have Medicare Part A and Part B. It does not offer Medicaid plans. If you are looking at WellMed, you are choosing a private insurance company that contracts with Medicare to deliver your hospital, doctor, and prescription drug coverage all in one plan.

The confusion is understandable: both Medicare and Medicaid are government health programs, but they serve different groups. Medicare is for people 65 and older, regardless of income. Medicaid is for people with lower incomes, and may be able to access varies by state. WellMed only works with Medicare.

WellMed operates in multiple states and offers different plan options depending on where you live. Not every state has WellMed plans available, and the plans offered vary by region. You can check whether WellMed serves your area by visiting their website or calling 1-800-877-7745.

Key Takeaways

  • WellMed is a Medicare Advantage company that serves people already enrolled in Medicare Part A and Part B, not a Medicaid provider.
  • Medicare Advantage plans like WellMed combine hospital, doctor, and prescription drug coverage into one plan with a single insurance card.
  • WellMed operates in select states and regions, so you need to confirm it is available in your area before considering enrollment.
  • If you are under 65 and looking for coverage, you would need to explore Medicaid through your state health department, not WellMed.
  • You can only join a WellMed plan during Medicare's open enrollment period (October 15 to December 7 each year) or if you are newly may be able to access for Medicare.

How WellMed Medicare Advantage plans work

When you choose a WellMed Medicare Advantage plan, you are switching from Original Medicare (Part A and Part B) to a managed care plan. WellMed becomes your insurance company and coordinates all your care. You pay a monthly premium to WellMed, and the plan covers hospital stays, doctor visits, and prescription drugs.

Most WellMed plans include prescription drug coverage built in, so you do not need to buy a separate Part D plan. Many plans also cover services that Original Medicare does not, such as dental, vision, or hearing care, though the coverage varies by plan and location.

In exchange for these benefits, WellMed plans typically have a network of doctors and hospitals you must use. If you see a provider outside the network, you may pay more out of pocket or the plan may not cover the visit at all. Some plans are HMOs (Health Maintenance Organizations), which require you to choose a primary care doctor. Others are PPOs (Preferred Provider Organizations), which give you more flexibility to see specialists without a referral.

What you need to know about WellMed plan costs

WellMed plans have different costs depending on which plan you choose and where you live. Most plans have a monthly premium, a yearly deductible, copayments for doctor visits, and coinsurance for hospital stays. Some WellMed plans have a $0 premium, meaning you pay nothing monthly beyond your Medicare Part B premium, but you may pay more at the doctor's office or hospital.

The out-of-pocket costs vary widely. One plan might charge $15 for a doctor visit and $250 for a hospital stay, while another charges $30 and $500. You need to compare the specific plans available in your area to see which costs fit your budget and health needs.

WellMed plans also have an out-of-pocket maximum, which is the most you will pay in a year for covered services. Once you reach that limit, the plan pays 100% of covered costs for the rest of the year. This maximum varies by plan but is set by Medicare each year.

When you can join a WellMed plan

You can join a WellMed Medicare Advantage plan during Medicare's Annual Enrollment Period, which runs from October 15 to December 7 each year. Any changes you make during this window take effect on January 1 of the following year. This is the main time to switch plans, switch from Original Medicare to Medicare Advantage, or switch from WellMed to another plan.

If you are newly may be able to access for Medicare (turning 65 or becoming may be able to access due to disability), you have a 7-month Initial Enrollment Period to join a plan. This period starts 3 months before the month you turn 65 and ends 3 months after. If you miss this window and do not join a plan, you may face a late enrollment penalty when you do join.

There are also special situations that allow you to join outside the regular enrollment period. If you lose other health coverage, move to a new state, or experience certain life events, you may have a Special Enrollment Period. Contact WellMed or Medicare directly to learn about you may have access to.

How WellMed differs from Original Medicare

Original Medicare is run by the federal government and covers hospital care (Part A) and doctor visits (Part B) nationwide. You can see any doctor or hospital that accepts Medicare. With Original Medicare, you buy a separate prescription drug plan (Part D) and may buy a Medigap supplemental plan to cover costs that Medicare does not.

WellMed Medicare Advantage is a private insurance plan that contracts with Medicare. You get all your coverage through one company, but you are limited to WellMed's network of doctors and hospitals. WellMed handles the paperwork and coordinates your care, which some people find simpler than managing multiple plans.

Original Medicare has higher out-of-pocket costs for some services but more flexibility in choosing providers. WellMed plans often have lower monthly costs but less choice in doctors. Neither is automatically better—it depends on your health needs, which doctors you want to see, and your budget.

Checking if WellMed serves your area

WellMed operates in Texas, Arizona, Florida, Oklahoma, and New Mexico, but not all counties in these states have WellMed plans. Coverage also changes from year to year as WellMed adds or removes service areas. The easiest way to learn about WellMed is available where you live is to visit Medicare.gov, enter your zip code, and see which plans show up in your area.

You can also call WellMed directly at 1-800-877-7745 to ask whether they offer plans in your county. Have your zip code ready. If WellMed does not serve your area, Medicare.gov will show you other Medicare Advantage plans available to you.

If you currently have a WellMed plan and move to a state or county where WellMed does not operate, you will lose your coverage at the end of the year. You will need to choose a different plan during the Annual Enrollment Period before your current plan ends.

Questions to ask your doctor before choosing WellMed

Before you join a WellMed plan, check whether your current doctors are in the network. Call your doctor's office and ask if they accept the specific WellMed plan you are considering. Some doctors accept one WellMed plan but not another, depending on the plan type (HMO vs. PPO) and the contract terms.

Ask your doctor about any specialists you see regularly. Make sure they are also in the WellMed network, or ask whether they can refer you to an in-network specialist. If your current doctors are not in the network and you want to keep seeing them, Original Medicare or a different Medicare Advantage plan may be a better fit.

Also ask your doctor's office about prior authorization requirements. Some WellMed plans require the doctor to get approval from WellMed before certain tests, procedures, or medications. This can add time to your care, so it is worth understanding how it works at your doctor's office.

Frequently Asked Questions

Can I have both WellMed and Medicaid at the same time?

If you are 65 or older and have both Medicare and Medicaid, you can have a WellMed Medicare Advantage plan. However, Medicaid will still cover some costs that Medicare does not, and the two programs coordinate. You cannot have a Medicaid plan from WellMed because WellMed only offers Medicare plans. Contact your state Medicaid office to understand how your Medicaid coverage works alongside Medicare.

What happens to my WellMed plan if I move out of state?

If you move to a state where WellMed does not operate, your plan will end on December 31 of that year. You will need to join a different Medicare Advantage plan or switch to Original Medicare during the Annual Enrollment Period before your coverage ends. Contact WellMed as soon as you know you are moving so they can explain your options and help you transition.

Do I need to stay with WellMed for a certain amount of time?

No. You can leave a WellMed plan and switch to a different plan or to Original Medicare during the Annual Enrollment Period each year. There is no lock-in period or penalty for switching. If you experience a may have access to life event (such as moving or losing coverage), you may also switch outside the annual enrollment window.

How do I know if WellMed is better than Original Medicare for me?

Compare the monthly premium, deductible, copayments, and out-of-pocket maximum for the WellMed plan against what you would pay with Original Medicare plus a Medigap plan and a Part D prescription drug plan. Also check whether your doctors and preferred hospitals are in the WellMed network. If your doctors are not in-network or you value the flexibility of Original Medicare, that may be the better choice for you.

Can I switch from WellMed to Original Medicare at any time?

You can switch during the Annual Enrollment Period (October 15 to December 7) or if you have a may have access to life event. Outside these windows, you cannot switch. If you want to leave WellMed, mark your calendar for the enrollment period and make the change then. Your new coverage will start on January 1.