Wellcare Medicare Advantage Plans

Due to the provision of Medicare Part C advantage plans being offered through many different private companies, your options can seem overwhelming when listed altogether – with so many benefits intersecting, there can be a confusion to considering who will genuinely provide you the coverage you most appropriately need. By facing your available healthcare provider’s selections individually, you can properly narrow down your feasible options one by one, bringing together the plan types best suited from each respective provider to your final decision. Take, in this example, the health management company Wellcare – this provider is available in several locations across the United States and, furthermore, has created its own division of plan types that the provider feels will best reach out to enrollees. 

In the modification of unique plan types, a few things must be accounted for – to properly level out all parts of a plan, especially reflective of the location where it will be sold, a plan’s network, costs (including copays and coinsurances,) as well as what benefits will be offered (or not) gets affected. Wellcare has considered this by creating several plan options with recognizable and simple names such as the Wellcare Advance, Wellcare Value, and so on, each with their own common associative network rules or costs; with this, despite the fact that a plan’s elements may change based on an enrollee’s location, they can familiarize themselves with the “type of coverage” they may receive with their chosen plan, and therefore, will remember it even if they move to another Wellcare applicable coverage area.

Remember – like any other healthcare provider supplying Medicare Part C advantage plans – the coverage you’ll find in any listed Wellcare advantage plan must be equal to, or greater, than your Original Medicare, meaning everything associated with familiar hospital and medical coverage. Below, we’ll take some examples from a zip-code in Memphis, Tennessee – an area with a significant amount of Wellcare enrollment – and see how certain plans within the area compare to one another (as well as up against any other healthcare provider’s plans you may be sizing up to.)

  1. The Wellcare HMO Options –

In most elements, either available Wellcare HMO plan still operates with similar considerations to likely any other healthcare provider’s HMO plan, requiring two functional rules to always be in play when making use of the plan’s coverage:

  • Wellcare’s HMO options require you to stay within its closed network of doctors, hospitals, pharmacies, and special facilities in order to receive correctly priced coverage. In the events where you improperly attempt to make use of your coverage at a non-network provider, you’ll likely be asked to pay completely out-of-pocket (or may not be accepted by the requested provider whatsoever.) As such, staying in network. While keeping your out-of-network services only limited to very necessary emergencies. allows you to most correctly stay within in the costs you’ll find on actual plan’s coverage.
  • Under this closed Wellcare network, you’ll be required to select an applicable Primary Care Provider (PCP) who can properly coordinate your services – this may involve being asked to leave your current provider, if they do not accept Wellcare, or select a new one before enrollment can be considered complete (if you do not currently have one.) Through this PCP, you’ll be required to receive all your referrals to recommended network-approved specialists, best allowing your care to be monitored and supervised collaboratively over the course of time.

Divided into two separate plan names, Wellcare provides two unique options for their HMO plans, in this area, based primarily on one factor – the presence of a Part B premium reduction, which allows the enrollee to theoretically “save money” through having to pay less for their Part B premium each month:

  1. Wellcare RX (HMO):

First, let’s consider the option without the Part B premium reduction…

  1. This plan’s monthly premium is $14.30.
  2. The plan’s annual deductible, preventive care, and primary care provider copay is $0; the copay for a Specialist, however, is $40.
  3. $6,700 maximum out-of-pocket responsibility (MOOP)
  4. Inpatient and Outpatient Hospital Care is provided – $275 copay per day for days 1-5, then $0 for days 6-90 in Inpatient Hospital; $125 – $250 copay in Outpatient Hospital, depending on location or service provided (ambulatory surgical center being the lower, outpatient hospital being the higher.)
  5. Both Emergency Room and Urgent Care are provided – a $90 copay for ER and a $30 copay for UC, respectively.
  6. Routine dental, vision, and hearing benefits are offered, including coverage for hearing aids, fillings, dentures, eyeglasses, and contact lenses.
  7. The plan comes with built-in prescription drug coverage at no additional premium, but with an annual drug deductible of $415 for all tiers – each drug falls into a tier between ranging between 1 to 5 with copays as low as $1 per drug (and as high as 25% of the retail cost.)
  8. Your Skilled Nursing Facility is provided – $0 per day for days 1-20, then $164.50 per day for days 21-100.
  9. Transportation is provided – 36 one-way trips, to plan approved locations, every year.
  10. You are given an Over-the-Counter Allowance of $60 every 3 months for the purchase of any Wellcare approved over-the-counter items.
  11. There is no SilverSneakers or equivalent gym membership provided.
  12. Both Home Healthcare and Hospice are covered at no cost.
  1. Wellcare Dividend (HMO): 

Now, let’s compare the above plan with the one below, which now includes a Part B premium reduction…

  1. This plan’s monthly premium is $0.
  2. This plan offers you a $30 Part B premium reduction, essentially putting $30 back into your pocket each month.
  3. The plan’s annual deductible and all preventive care is $0. However, the primary care provider copay is $5, with the copay for a Specialist is $50.
  4. $6,700 maximum out-of-pocket responsibility (MOOP)
  5. Inpatient and Outpatient Hospital Care is provided – $1,450 copay per stay for Inpatient Hospital; $125 – $350 copay in Outpatient Hospital, depending on location (ambulatory surgical center being the lower, outpatient hospital the higher.)
  6. Both Emergency Room and Urgent Care are provided – a $90 copay for ER and a $35 copay for UC, respectively.
  7. Routine dental, vision, and hearing benefits are offered, including coverage for hearing aids, dental cleanings, eyeglasses, and contact lenses.
  8. The plan comes with built-in prescription drug coverage at no additional premium or deductible – each drug falls into a tier between ranging between 1 to 5 with copays as low as $4 per drug (and as high as 33% of the retail cost.)
  9. Your Skilled Nursing Facility is provided – $0 per day for days 1-20, then $164.50 per day for days 21-100.
  10. Transportation is not covered.
  11. You are given an Over-the-Counter Allowance of $50 every 3 months for the purchase of any Wellcare approved over-the-counter items.
  12. There is a gym membership provided, as well as additional fitness coverage.
  13. Both Home Healthcare and Hospice are covered at no cost.

You’ll see that, despite the fact that these are both Wellcare provided HMO plans in the same area, they represent drastically different coverage perspectives – you may find that an ancillary benefit like Transportation is a make-or-break consideration of your enrollment into a plan, but it can feel weighed against the massive difference between one plan’s Inpatient Hospital Care copay to another or by the presence of a plan premium. 

The benefit of having a small choice between options means that recognizable shifts can be made to certain portions of plans with familiar networks, assuring that there’s a possibility for plans to better apply to certain situations, all while making you feel less overwhelmed by so many selections with very minor tweaks (and potentially very similar names.)

  1. The Wellcare HMO-POS Options – 

With very close similarity to other HMO counterparts, Wellcare’s HMO-POS policies serve to provide a small potential for out-of-network servicing in an area if preferred by the client – essentially, when enrolled into an HMO-POS plan, your expectations regarding Wellcare’s network, covered doctors, drug formula, and need for referrals stay primarily the same; the change arises from listed plan prices for services rendered outside of the Wellcare network, equating an actual cost to these actions rather than making you pay completely out-of-pocket.

In the following examples of two Wellcare HMO-POS plans, you’ll notice costs associated with both an in- and out-of-network purpose; remember – much of the coverage used out-of-network will require a fair and just reasoning to fully take advantage of, and as such, may only be available in only a few circumstances fitting the proper parameters.  

  1. Wellcare Value (HMO-POS):

The Wellcare Value (HMO-POS) provides many of the standard benefits you might expect on another other Wellcare HMO, but with a very standardized concept towards how much you’ll be expected to pay for basically anything done out-of-network – nearly everything, out-of-network, is listed at 40% the actual cost of the service!

  1. This plan’s monthly premium is $0.
  2. The plan’s annual deductible, preventive care, and primary care provider copay is $0; the copay for a Specialist, however, is $45. Out-of-network, both types of doctor’s services, as well as any preventive care, is at 40% of its cost.
  3. $6,000 maximum out-of-pocket responsibility (MOOP) for both strictly in-network, as well as for in- and out-of-network combined.
  4. Inpatient and Outpatient Hospital Care is provided – $325 copay per day for days 1-5 in-network, then $0 for days 6-90 in Inpatient Hospital; $150 – $325 copay for in-network Outpatient Hospital, depending on location or service provided (ambulatory surgical center being the lower, outpatient hospital being the higher.) Out-of-network, everything listed above is 40% of its non-covered cost.
  5. Both Emergency Room and Urgent Care are provided – a $90 copay for ER and a $40 copay for UC, respectively.
  6. Routine dental, vision, and hearing benefits are offered – however, coverage for hearing aids, fillings, dentures, eyeglasses, and contact lenses is only provided in-network. Any routine coverage used out-of-network for any of these benefits will result in 40% of the cost.
  7. The plan comes with built-in prescription drug coverage at no additional premium, with no additional drug deductible – each drug falls into a tier between ranging between 1 to 5 with copays as low as $2 per drug (and as high as 33% of the retail cost.)
  8. Your Skilled Nursing Facility is provided – $0 per day for days 1-20, then $164.50 per day for days 21-100. Out-of-network, a Skilled Nursing Facility is 40% of the cost.
  9. Transportation is not covered.
  10. You are given an Over-the-Counter Allowance of $50 every 3 months for the purchase of any Wellcare approved over-the-counter items.
  11. There is a gym membership provided, as well as additional fitness coverage.
  12. Both Home Healthcare and Hospice are covered at no cost.
  1. Wellcare Advance (HMO-POS): 

The Wellcare Advance, however, is much more tailored to a person who may be looking for an option void of prescription drug coverage – in many cases, healthcare providers may supply plans like such to give flexibility to those who may want to keep their stand-alone prescription drug coverage (or may not take any prescriptions at all,) all while being able to greatly lower their costs across the rest of the policy.

  1. This plan’s monthly premium is $0.
  2. This plan offers you a $30 Part B premium reduction, essentially putting $30 back into your pocket each month.
  3. The plan’s annual deductible and preventive care is $0 in-network. When seeing your primary care provider, the copay is $5 in-network; the copay for a Specialist, however, is $35 in-network. Out-of-network, both types of doctor’s services, as well as any preventive care, is at 20% of its cost.
  4. $4,500 maximum out-of-pocket responsibility (MOOP) for both strictly in-network, as well as for in- and out-of-network combined.
  5. Inpatient and Outpatient Hospital Care is provided – $350 copay per day for days 1-5 in-network, then $0 for days 6-90 in Inpatient Hospital; $100 – $150 copay for in-network Outpatient Hospital, depending on location or service provided (ambulatory surgical center being the lower, outpatient hospital being the higher.) Out-of-network, everything listed above is 20% of its non-covered cost.
  6. Both Emergency Room and Urgent Care are provided – a $90 copay for ER and a $35 copay for UC, respectively.
  7. Routine dental, vision, and hearing benefits are offered – however, coverage for hearing aids, fillings, dentures, eyeglasses, and contact lenses is only provided in-network. Any routine coverage used out-of-network for any of these benefits will result in 20% of the cost.
  8. This plan does not come with provided prescription drug coverage, requiring you to enroll into a separate stand-alone Part D drug coverage alongside this plan to receive proper drug assistance.
  9. Your Skilled Nursing Facility is provided – $0 per day for days 1-20, then $164.50 per day for days 21-100. Out-of-network, a Skilled Nursing Facility is 20% of the cost.
  10. Transportation is covered – 24 one-way trips, to plan approved locations, provided every year.
  11. You are given an Over-the-Counter Allowance of $75 every 3 months for the purchase of any Wellcare approved over-the-counter items.
  12. There is a gym membership provided, as well as additional fitness coverage.
  13. Both Home Healthcare and Hospice are covered at no cost.
  1. Wellcare Special Needs Plans – 

Typically, the provision of Special Needs Plans (SNPs) from healthcare providers doesn’t really sway much from other competitors – the entire purpose of SNPs is to provide a plan with low or no costs to those who would most need it, as such the circumstances for those in long-term care or at a certain level of Medicaid. 

When applicable to be enrolled into a Special Needs Plan, you’ll both need to meet a prior requirement necessary to enroll and consider if the plan’s attached network will be acceptable for your needs; SNPs do not have their own unique policy about network operations, and therefore, are generally associated with either an HMO or a PPO plan (giving definition to your ability to operate in or out of a network, as well as, alert towards any potentially minor costs.)

One of Wellcare’s SNP options, the Wellcare Access (HMO-SNP) brings nearly all plan costs to $0, with just a few listings including:

  • Inpatient and outpatient hospital copays
  • Doctor visit copays (both primary and specialist)
  • Skilled nursing facility copay 
  • Emergency Room and Urgent Care copays 
  • Diagnostic Services, including radiology, x-rays, and any tests or procedures
  • Your ambulance, mental health, and therapy

Now, per the standard of most SNP, you’ll also be automatically provided drug coverage under the healthcare provider’s formulary, providing an applicable listing of drugs that will be acceptably covered when enrolled – all SNP plans will come along with included prescription drug coverage, almost universally making all drug tiers cost between $0 to a maximum of $8.50 per drug.

Additionally, you’ll be boosted up on benefits like higher maximum spending limits and allowances, such as the case with:

  • Over-the-counter materials
  • Dental coverage, including (but not limited to) dentures, fillings and extractions
  • Hearing coverage, including hearing aids
  • Vision coverage, including eyeglasses or contact lenses

References Used:

https://www.wellcare.com/en/tennessee/members/medicare-plans-2019/wellcare-rx-hmo
https://www.wellcare.com/en/tennessee/members/medicare-plans-2019/wellcare-dividend-hmo-pos
https://www.wellcare.com/en/tennessee/members/medicare-plans-2019/wellcare-value-hmo
https://www.wellcare.com/en/tennessee/members/medicare-plans-2019/wellcare-advance-hmo-054
https://www.wellcare.com/en/tennessee/members/medicare-plans-2019/wellcare-access-hmo-snp