WellCare is a private insurance company that offers Medicare Advantage and Part D plans.
Medicare Advantage plans are an all-in-one alternative to original Medicare, which is Part A, hospital insurance, and Part B, medical insurance. They also usually include prescription drug coverage, otherwise available by Medicare Part D, which a person can buy to add to their original Medicare coverage.
This article introduces WellCare, a private insurance company that offers Advantage plans, and discusses the coverage and costs of Medicare Advantage. It then provides information on WellCare Part D plans, and looks at the coverage and costs of Medicare Part D.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
WellCare Health Plans, Inc. is a health insurance company that focuses mainly on providing government-sponsored managed care services. It offers Medicare Advantage and Medicare Part D as primary health plans.
In 2018, more than 5 million people were enrolled in the company’s plans.
Medicare Advantage is a group of insurance plans that provide benefits covered under Medicare Part A and Part B.
WellCare Advantage plans
Medicare plans from WellCare are available in many states. People can use this tool to find out more about the plans available in their state.
All WellCare Advantage Plans provide Part A and Part B coverage. They also offer a 24-hour advice line to get answers to medical questions, as well as at-no-charge preventive services, such as an annual flu shot and doctor’s checkup.
Most of the plans offer prescription drug coverage, and they may include extra benefits such as dental, vision, and hearing care.
Medicare Advantage Plans
Most Medicare Advantage plans include Medicare Part A and Part B, as well as prescription drug coverage. They may offer extra benefits that original Medicare does not provide.
The most common kinds of plans include:
- Health Maintenance Organization (HMO) plans: Most HMOs require a person to choose from in-network providers. Although some plans permit the choice of out-of-network providers, these usually involve higher costs.
- Preferred Provider Organization (PPO) plans: PPOs give someone the flexibility to pick from in-network or out-of-network providers. However, as with HMOs, the in-network providers cost less.
- Private Fee-for-Service (PFFS) plans: PFFS plans have a set fee for what they pay doctors, hospitals, and other care providers. They also have a set fee for what the person with the plan pays.
- Special Needs Plans (SNPs): SNPs design the benefits to meet the specialized needs of people with certain diseases. Generally, an individual must choose only from in-network providers.
Costs of Advantage plans
Costs associated with Medicare Advantage vary with the plan and the companies offering them.
The average monthly premium in 2019 was $29, according to the Kaiser Family Foundation (KFF). Other costs include copayments, coinsurance, and a deductible.
Some plans pay all or part of the Medicare Part B monthly premium. If the plan does not pay any of this, the basic premium is $144.60.
All Advantage plans put a cap on yearly healthcare costs. Once the costs exceed this amount, a person does not have to pay anything.
WellCare Part D plans
WellCare Part D plans provide outpatient prescription drug coverage and are available in every state. The plan that best suits an individual depends on several factors, such as coverage and prescriptions.
Pharmacies in the WellCare network include mail service, retail, long-term care, specialty, Indian Health Service/Tribal/Urban Indian Health Program (I/T/U), and home infusion. A person can use this tool to get more information about pharmacies in their area.
If a person uses an out-of-network pharmacy, they may have to pay more. However, a person may be covered by their plan if unable to use a network pharmacy for one of several reasons.
Medicare Part D plans
Because original Medicare does not cover prescription drugs, Medicare offers coverage through Part D plans. The plans vary in their benefits, but they all provide standard coverage.
Each plan has a formulary, which is a list of medications it covers. The formularies offer a minimum of two drugs in all of the most frequently prescribed treatment areas.
Part D plans divide their coverage into categories called tiers, and each tier has a different copayment:
- Tier 1 has the lowest copayment and includes most generic drugs.
- Tier 2 includes preferred name brand drugs.
- Tier 3 includes nonpreferred name brand medications.
- The specialty tier includes high-cost drugs.
Costs of Part D plans
The costs involved in Part D plans vary. On average, the monthly premium is $32.74. Other costs include coinsurance, copays, and a deductible. If an individual has a low income, they may qualify for Extra Help, a program that provides approximately $5,000 worth of assistance with prescription costs per year.
A person may use this Medicare tool to find an Advantage or Part D plan in their area. If someone is interested only in WellCare plans, they can check the company’s website to see which plans are available where they live.
The private insurance company WellCare Plans, Inc. offers two kinds of Medicare plans.
One type of plan, Medicare Advantage, is an alternative to original Medicare, and includes hospitalization, medical, and prescription drug coverage. Advantage plans also frequently offer extra benefits such as dental.
WellCare’s other type of Medicare insurance, Part D, offers prescription drug plans to a person who has original Medicare.
People who are interested in these plans may wish to compare the coverage and costs of options offered by WellCare. Because costs vary among companies, they may also consider shopping around before they decide on a plan.