Wellcare is a Medicare insurance company that offers plans in all three main types: Original Medicare supplements, Medicare Advantage, and prescription drug coverage

Wellcare is a private insurance company that contracts with Medicare to sell plans to people 65 and older and some younger people with disabilities. You do not buy Wellcare directly from Medicare — you buy from Wellcare itself, but the plans must follow Medicare rules. Wellcare operates in most states and offers Medigap plans (which fill gaps in Original Medicare), Medicare Advantage plans (which replace Original Medicare), and standalone prescription drug plans.

The specific plans Wellcare offers, their costs, and which doctors and pharmacies are in-network change by state and year. Wellcare is owned by Centene Corporation, a large health insurance company, so it has the resources to operate in many regions, but that does not mean every Wellcare plan is available where you live.

Key Takeaways

  • Wellcare sells Medigap plans that work alongside Original Medicare, Medicare Advantage plans that replace it, and standalone prescription drug plans — the type you need depends on which Medicare coverage you already have.
  • Wellcare plans are available in most but not all states, and the specific plans, costs, and in-network providers differ by location and change each year.
  • You enroll in Wellcare plans directly through Wellcare's website or by phone, not through Medicare.gov, though Medicare.gov has a plan-finder tool that shows Wellcare options in your area.
  • Wellcare Medicare Advantage plans often include dental, vision, or hearing benefits that Original Medicare does not cover, but you must use in-network doctors and may pay more if you see out-of-network providers.

The three types of Wellcare Medicare plans

Medigap plans (also called Supplemental Insurance) work with Original Medicare. You keep your Original Medicare coverage and add a Wellcare Medigap plan to cover costs that Original Medicare does not — like copayments, coinsurance, and deductibles. Wellcare offers several Medigap plan letters (Plan A, Plan B, Plan C, Plan D, and others), each covering a different set of out-of-pocket costs. A Medigap plan does not cover prescription drugs, so you would need to enroll in a separate prescription drug plan.

Medicare Advantage plans (also called Part C) replace Original Medicare entirely. Instead of paying Medicare directly, you pay Wellcare, and Wellcare becomes your insurance company for hospital, doctor, and specialist visits. Most Wellcare Medicare Advantage plans include prescription drug coverage built in, and many add dental, vision, or hearing benefits. The trade-off is that you must use Wellcare's network of doctors and hospitals — going out of network usually costs more or is not covered at all.

Standalone prescription drug plans (Part D) cover the cost of medications. If you have Original Medicare and a Medigap plan, you need a separate Part D plan. If you have a Wellcare Medicare Advantage plan, prescription coverage is usually included, so you would not buy a standalone plan. Wellcare offers Part D plans in most states.

How Wellcare Medicare Advantage plans differ from Original Medicare

Original Medicare is run by the federal government and covers hospital stays (Part A) and doctor visits (Part B) with no network restrictions — you can see any doctor who accepts Medicare. Wellcare Medicare Advantage plans are run by Wellcare as a private company and limit you to doctors and hospitals in Wellcare's network. If you see an out-of-network doctor, you typically pay more or the visit is not covered.

Wellcare Medicare Advantage plans often cost less in monthly premiums than Original Medicare plus a Medigap plan, and they usually include prescription drug coverage and extra benefits like dental or vision. However, you give up the freedom to see any doctor, and you may need prior approval from Wellcare before certain procedures or specialist visits. If you travel frequently or see doctors outside your home state, a Medigap plan with Original Medicare may be a better fit.

Wellcare Medicare Advantage plans also have an out-of-pocket maximum — a yearly limit on what you pay for in-network care. Once you reach that limit, Wellcare covers the rest of your in-network care for the year. Original Medicare has no out-of-pocket maximum, which means costs can be unpredictable if you have a serious illness or injury.

Costs: premiums, deductibles, and copayments

Wellcare plan costs vary widely by state, plan type, and year. Monthly premiums for Wellcare Medicare Advantage plans range from $0 to several hundred dollars depending on the plan and location. Medigap plans typically have higher monthly premiums but lower out-of-pocket costs when you use care. Prescription drug plans have their own monthly premiums and cost-sharing for medications.

When you enroll in a Wellcare plan, you will see the exact premium, deductible, copayment, and coinsurance amounts for that plan in your state. These costs are set each year and published before the annual enrollment period (October 15 to December 7). You can compare Wellcare plans side by side on Medicare.gov's plan-finder tool or on Wellcare's website.

Remember that you still pay your Medicare Part B premium (currently $164.90 per month for most people in 2024, though this amount changes yearly) on top of any Wellcare plan premium. If you have a Wellcare Medicare Advantage plan, that premium is usually included in what you pay Wellcare, but confirm this when you review your plan details.

How to find and enroll in a Wellcare plan

Start by going to Medicare.gov and using the "Find Care Providers & Suppliers" or "Plan Finder" tool. Enter your zip code and the tool will show you all Wellcare plans available in your area, along with their costs and coverage details. This is the fastest way to see what Wellcare offers where you live.

Once you find a Wellcare plan you want, you can enroll directly through Wellcare's website or by calling Wellcare's enrollment line. You can also enroll through Medicare.gov itself — the website will walk you through the process. Enrollment outside the annual enrollment period (October 15 to December 7) is usually only open if you have a may have access to life event, such as losing employer coverage, moving to a new state, or turning 65.

If you are already enrolled in a Wellcare plan and want to switch to a different Wellcare plan or a plan from another company, you can make changes during the annual enrollment period. You can also switch from a Medicare Advantage plan back to Original Medicare and a Medigap plan during this window, though some Medigap plans may require medical underwriting if you have not had continuous Medigap coverage.

Wellcare's network and coverage area

Wellcare operates in most U.S. states, but not all Wellcare plans are available everywhere. Some states have robust Wellcare Medicare Advantage offerings with many plan options, while others have only Medigap or Part D plans. Rural areas sometimes have fewer Wellcare plans than urban areas.

Before you enroll, check whether your current doctors and hospitals are in Wellcare's network for the specific plan you are considering. Wellcare's website has a provider search tool where you can enter your doctor's name or location and see if they are in-network. If your main doctor is not in Wellcare's network, you may want to choose a different plan or switch to Original Medicare with a Medigap plan, which has no network restrictions.

Frequently Asked Questions

Can I switch from Wellcare to a different Medicare plan?

Yes. During the annual enrollment period (October 15 to December 7), you can switch to any other Medicare plan, including plans from other companies or back to Original Medicare. If you switch from a Wellcare Medicare Advantage plan to Original Medicare, you have a may provide right to buy a Medigap plan from any company without medical underwriting, as long as you enroll within 63 days of losing your Medicare Advantage coverage.

Does Wellcare cover dental and vision?

It depends on the plan. Many Wellcare Medicare Advantage plans include dental and vision benefits, but Original Medicare and Medigap plans do not. Check your specific Wellcare plan's summary of benefits to see what is included. Standalone dental and vision plans are also available from other companies if your Wellcare plan does not cover them.

What happens if I see a doctor outside Wellcare's network?

If you have a Wellcare Medicare Advantage plan and see an out-of-network doctor, you usually pay more or the visit is not covered at all, except in emergencies. If you have a Wellcare Medigap plan, you can see any doctor who accepts Medicare, and your coverage works the same way as Original Medicare. Check your plan documents for the exact out-of-network rules.

Do I need to choose a primary care doctor with Wellcare?

Most Wellcare Medicare Advantage plans require you to choose a primary care doctor and get referrals to see specialists. Wellcare Medigap plans do not have this requirement because they work with Original Medicare, which does not use primary care doctors or referrals. Check your specific plan to confirm.

How do I know if Wellcare is available in my state?

Use the plan finder on Medicare.gov and enter your zip code. If Wellcare plans appear in the results, they are available in your area. You can also call Wellcare directly at the number on their website to ask what plans they offer in your state.