What Medicare Plans Does WellCare Offer?

Jory Cross by Jory Cross | Licensed since 2012
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This article was updated on: 10/21/2018

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Whether you’re new to Medicare or exploring your coverage options, Wellcare offers a variety of Medicare plans to suit your needs. To start, it may be helpful to understand the different “parts” of Medicare and how they work together.

The Medicare program has four separate components:

  • Part A (hospital insurance)
  • Part B (medical insurance)
  • Part C (Medicare Advantage)
  • Part D (prescription drug coverage)

Original Medicare (made up of Part A and Part B) is administered by the federal government, while Part C and Part D coverage is available through private insurance companies like Wellcare, which contract with the Medicare program to offer Wellcare Medicare Advantage plans and stand-alone Wellcare Medicare Prescription Drug Plans.

Here’s an overview of how each of these types of Medicare coverage works and Wellcare Medicare plans that you may be eligible for.

Wellcare Medicare plans with coverage for prescription drugs

Wellcare Medicare plans with prescription drug coverage may be available in your area. As a Medicare beneficiary, you’re eligible for Part D coverage if:

  • You have Medicare Part A and/or Part B.
  • You live in the service area of a Medicare plan that offers prescription drug coverage.

There are several ways to get your Wellcare Medicare Part D prescription drug coverage, depending on whether you’re enrolled in Original Medicare or Medicare Part C. This includes Wellcare Medicare Prescription Drug Plans, which are stand-alone plans that work alongside Original Medicare, as well as Medicare Advantage Prescription Drug plans, which include your Part A, Part B, and Part D benefits under a single plan.

If you decide to stay with Original Medicare and get your Part D coverage with a stand-alone Wellcare Medicare Part D Prescription Drug Plan, keep in mind that these plans are designed to supplement your coverage under Original Medicare and generally cannot be combined with Wellcare Medicare Advantage plans that may include prescription drug coverage, such as Health Maintenance Organization (or HMOs) and Preferred Provider Organization* (or PPOs). If you’re enrolled in Medicare Part C, you should get your prescription drug coverage through your Medicare Advantage plan (if available), and not through a stand-alone plan. In fact, if you enroll in a Medicare Prescription Drug Plan when you’re already enrolled in a Medicare Advantage Prescription Drug plan, you’ll be automatically disenrolled from your Medicare Advantage plan and returned to Original Medicare.

The only time you may be allowed to enroll in a Medicare Prescription Drug Plan with your Medicare Advantage plan is if you have a type of Medicare Advantage plan that doesn’t include prescription drug benefits (such a Medicare Savings Account plan or certain Private Fee-for-Service plans); in this case, you may be allowed to enroll in a stand-alone Medicare Prescription Drug Plan for your Part D benefits. Always double check with the Medicare plan how your enrollment may affect other types of coverage you currently have.

Other things to keep in mind when it comes to Medicare prescription drug coverage:

  • All Medicare plans that include prescription drug benefits use a formulary to determine benefits. A formulary is a list of covered medications and plan benefits allowed for each (including what your plan will cover and what your costs will be for those medications). Plans may change their formularies from time to time, but they must notify you in writing before they do.
  • You should sign up for Medicare Part D coverage as soon as you are eligible, or you may need to pay an extra late-enrollment penalty with your monthly premium for as long as you are covered. You may owe a late-enrollment penalty any time you go without Part D after you’re eligible and don’t have creditable prescription drug coverage (coverage that pays, on average, as much as the standard Part D benefit) for 63 consecutive days or more.
  • Not all plans are available in all areas and plan premiums may vary depending on where you live.

Wellcare Medicare

Medicare Advantage (Part C) is an alternative way to get your Original Medicare, Part A and Part B, benefits. Instead of having your benefits administered through the federal program, you can get your Medicare coverage through a Medicare Advantage plan instead.

You may be eligible for Medicare Advantage plans if:

  • You have Medicare Part A and Part B.
  • You live in the service area of a Medicare Advantage plan.
  • You don’t have end-stage renal disease (with some exceptions).

Wellcare Medicare Advantage plans are required by law to provide at least the same coverage as Original Medicare (except for hospice care, which is still covered under Part A). Many plans may offer additional benefits such as coverage for routine vision and dental services, or prescription drug coverage. You must continue to pay your Part B premium if you enroll in a Wellcare Medicare Advantage plan, plus any additional premium required by your plan.

Depending on your service area, you may have several types of Wellcare Medicare Advantage plan options available to you. Many Wellcare Medicare Advantage plans may include prescription drug coverage, but not every plan does. If you’re interested in coverage for prescription drugs, confirm with the specific Medicare Advantage plan you’re interested in to make sure this coverage is included.

Some of the types of Wellcare Medicare Advantage plans that may be offered in your service area include:

  • Wellcare MedicareAdvantage Health Maintenance Organization (HMO) plans. These plans often include coverage for prescription drugs and require you to choose a primary care physician to oversee your care. You need to use network providers to be covered (with the exception of medically necessary emergency treatment). You’ll need to get a referral from your primary care doctor if you want to see a specialist.
  • Wellcare MedicareAdvantage Preferred Provider Organization (PPO) plans. You have the flexibility to use both in-network and out-of-network providers with these plans, but you save on your out-of-pocket costs if you get care from doctors and hospitals within the plan’s preferred provider network. These plans often offer coverage for prescription drugs. No referrals are needed for specialist care.

Wellcare Medicare Advantage Special Needs Plans (SNPs). These plans limit enrollment to people with certain disabling or chronic conditions; those who live in institutions or require nursing-level care at home; and those who are dual eligibles (have both Medicare and Medicaid benefits). You must meet the eligibility criteria of the plan to enroll. These plans always include prescription drug coverage, and plan benefits are tailored to meet the needs of its members. For example, if you’re enrolled in a Chronic-Condition Special Needs Plan or SNP, your plan might include specialized provider networks, formularies, or wellness programs to help you better manage your medical condition.

Not all plans may be available in all service areas, and plan benefits and premiums may vary depending on where you live.

As you can tell, you have many options as a Medicare beneficiary that go beyond Original Medicare. Would you like to learn more about Medicare plan options that may fit your specific situation, budget, or health needs? To get started, you can:

  • Learn more about Wellcare Medicare coverage by clicking on the Wellcare Medicare page.
  • If you’re ready to start comparing plan options right now, click on the Find Plans button on this page; you can customize your search by plan type or even enter in your prescription drugs to find plan options that cover your medications.

* Out-of-network/non-contracted providers are under no obligation to treat Wellcare 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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