What Medicare Advantage Plans Does WellCare Have?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 10/21/2018

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If you are currently enrolled in Medicare, or approaching Medicare eligibility, you may have questions about the different coverage options under the Medicare program. WellCare, a Medicare-approved private insurance company, offers several Medicare Advantage plans for beneficiaries who want an alternative way to receive their Original Medicare (Part A and Part B) benefits. By law, Medicare Advantage plans must offer the same coverage as Original Medicare, except for hospice care, which is still covered under Part A.

Keep in mind that there are several different types of Medicare Advantage plans; WellCare may not offer every option in every location. Some of these plan types are described below. Plan choices and benefits, as well as premiums, may depend on where you live.

What is a WellCare Medicare Advantage Health Maintenance Organization or HMO plan?

A Health Maintenance Organization, or HMO, plan can be a cost-effective Medicare Advantage option. Here are some common features of an HMO:

  • You must get your health care from doctors, hospitals, and other facilities in your plan’s network; if you get care out-of-network, you may have to pay the full cost. Your HMO does cover certain emergency care outside the network, however.
  • You’ll need to choose a primary care doctor who will oversee all aspects of your care; in most cases, you need a referral to see a specialist.
  • Most HMOs include coverage for a list of approved prescription drugs, known as a “formulary.” Each plan develops its own formulary, which may change at any time; your plan will notify you of any changes to your prescription drug coverage.

What is a WellCare Medicare Advantage Preferred Provider Organization or PPO plan?

A Preferred Provider Organization, or PPO*, plan offers enrollees more flexibility in choosing their health-care providers. Typical features include:

  • You may get your health care from any doctor or facility you prefer, but you generally pay less if you use providers in the plan’s network.
  • You don’t need to choose a primary care doctor or get a referral (in most cases) to see a specialist of your choice.
  • Usually, PPOs include prescription drug coverage, as described above.

What is a WellCare Private Fee for Service or PFFS plan?

These plans (like all Medicare Advantage plans) are only available through private insurance companies approved by Medicare, but it’s important to note that a provider who accepts Medicare assignment may not be required to accept your Private Fee for Service (PFFS) plan, depending on whether the plan has a provider network. Each PFFS plan determines its own provider reimbursement rates and member cost schedules. Unless your PFFS plan has a network, you must ask each time you seek care whether the provider accepts the payment terms of your PFFS plan, even if he or she has seen you before. Other things to know:

  • You may see any doctor or provider who agrees to accept your plan’s terms and conditions.
  • Except in the case of an emergency, a doctor or hospital does not have to treat you or accept your plan if the plan doesn’t have a provider network.
  • Some PFFS plans have a network of contracted providers who have contracted with the plan treat you, even if you’ve never been a patient with a particular provider before.
  • Some plans include coverage for prescription drugs; if your plan doesn’t, you may enroll in a separate stand-alone Medicare Part D Prescription Drug plan.
  • If a provider refuses to accept your PFFS plan, you can’t use your original red, white, and blue Medicare card to get treatment; Original Medicare won’t pay as long as you are enrolled in a Medicare Advantage PFFS plan.

What is a Medicare Advantage Special Needs Plan or SNP?

Medicare SNPs, or Special Needs Plans, are Medicare Advantage plans that are only available to people who have certain chronic diseases or conditions, such as diabetes or End-Stage Renal Disease (ESRD). Plan benefits, providers, and covered prescription drugs are tailored toward managing their enrollees’ unique health needs. Other things to note about SNPs:

  • You are usually required to have a primary care doctor or care coordinator to handle your ongoing care; in most cases, you need a referral for specialty care.
  • All SNPs are required to include prescription drug coverage.
  • SNP plan membership is limited to: people in nursing homes or who need home nursing care; those who have both Medicare and Medicaid; and those who suffer from a qualifying health condition such as (but not limited to) HIV/AIDs or chronic heart failure.
  • If you qualify for an SNP, you can enroll anytime.

Plan specifics may vary, so you may want to contact any WellCare Medicare Advantage plan you’re considering and go over coverage details to see if it’s a good match for your needs. Please note that no matter what type of WellCare Medicare Advantage plan you sign up for, you’re still enrolled in the Medicare program, and you need to continue paying your Part B monthly premium.

Would you like to start comparing Medicare plans right now? You just enter your zip code and click Find Plans in the form on this page.  Find out more about WellCare Medicare coverage.

*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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