How Can I Find Healthcare Providers Who Accept WellCare Medicare Plans?

Last Updated : 10/21/20184 min read

Many WellCare Medicare Advantage plans and stand-alone WellCare Medicare  Part D Prescription Drug plans require you to use network providers for your routine care and prescription medications (except in emergency situations), to offer you lower out-of-pocket costs if you use preferred providers in the WellCare Medicare provider network.

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Here’s what you should know about finding and using providers who accept your WellCare Medicare plan. 

Why should I use WellCare Medicare network providers?

Some types of Medicare Advantage plans, such as Health Maintenance Organizations (HMOs), set up networks of providers who agree to treat plan members at a certain rate; this system is designed to keep costs down. If you have a WellCare Medicare Advantage HMO plan, you may be required to get all your medical care from network providers (except for medically necessary emergency treatment, which is covered even if you are out of your plan’s network). If you get care out-of-network, you may have to pay the full cost of your treatment.

With other plans, such as WellCare Medicare Advantage Preferred Provider Organization (PPO)* plans, you may pay higher out-of-pocket costs if you get care from someone not in the plan’s preferred provider network, and in that case:

  • Your copayment may be higher.
  • You may have to pay a higher coinsurance amount for your care. For example, if your plan pays 80% of Medicare covered costs with preferred providers, it might only pay 50% for out-of-network providers.
  • The fees charged by a non-network provider for a particular service may be higher than the fee charged by a preferred provider.

WellCare contracts with certain providers to offer you special rates for your care, usually lower than what they would charge you if you were not enrolled in a WellCare Medicare health plan. In addition, network providers and pharmacies agree to accept your copayment or coinsurance amount as your payment in full for your Medicare covered services or prescription drugs, saving you money out-of-pocket.

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The WellCare provider network may include primary care doctors, specialists, hospitals, pharmacies, labs, and other medical providers necessary for your care.

Do I need to use a WellCare network pharmacy for my WellCare Medicare prescription drug coverage?

Depending on your plan, you may need to get your prescription medications from WellCare network pharmacies. In some cases, you may also be eligible for additional savings by using a WellCare preferred pharmacy or signing up for mail order delivery through the CVS/Caremark mail service program. To find out if you’re eligible, use the .

How do I find health-care providers who accept my WellCare Medicare plan?

It’s easy to find providers who accept your WellCare Medicare Advantage or stand-alone WellCare Medicare Part D Prescription Drug Plan using this . You’ll need to know your plan name to use the tool, and you can search by city, state, zip code, or by provider type, including doctors, hospitals, and pharmacies.

If you have questions about using the online tool, can’t find a network provider in your area, or have any other questions about your WellCare Medicare health plan, you can also call the customer service number at 1-866-530-9491 (TTY 1-877-247-6272) from Monday through Sunday, 8 a.m. to 8 p.m.

Visit this WellCare page to find out more about WellCare Medicare coverage options. Want to start comparing plans right now? Use the Find Plans button for that.

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

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