WellCare Medicare Advantage 2021 Review

WellCare is part of Centene Corporation, which is the sixth-largest provider of Medicare Advantage plans [1]. Centene completed its acquisition of WellCare in early 2020 [2].

Though WellCare and Centene have joined forces, WellCare’s ratings are lower than other providers' numbers. Only about a quarter of WellCare’s members who are in contracts with a Medicare Star Rating are in contracts with a rating of 4 or higher (out of 5). WellCare’s plans struggle in a number of categories, and member satisfaction places them behind other Medicare Advantage providers.

Here’s what you should know about WellCare Medicare Advantage.

WellCare Medicare Advantage pros and cons

WellCare’s offerings have upsides and downsides:

Pros

Company strength: In 2020, Centene completed its acquisition of WellCare, and the combined entities boosted their presence in the Medicare Advantage market, moving from 1.24% in 2020 to 4.14% of the market in 2021 [3].
Extra benefits: Some WellCare plans include the Flex Card, which comes preloaded with additional funds members can use on dental, vision and hearing benefits once they’ve exhausted their plan coverage.
Meal delivery: Some plans include no-copay meal delivery from Shipt for a specified number of days, such as three meals a day for up to 98 days.
Part B premium coverage: Some plans include a Give Back benefit that refunds some or all of your Part B premium.

Cons

Lower star ratings. In 2021, WellCare’s average star rating from Medicare is 3.4 stars (out of 5 stars), compared with an overall average among all Medicare Advantage plans of 4.06 stars. WellCare’s contracts also score poorly on a number of individual factors, from the percentage of plan members who get a flu shot to how easy it is for members to get needed care.
Member discontent. When it comes to member satisfaction, J.D. Power found that Centene (which acquired WellCare in early 2020) came in last out of the nine Medicare Advantage companies ranked.
Limited state coverage. WellCare only offers Medicare Advantage plans in 27 states, and Special Needs Plans, or SNPs, in 25 states.

Available WellCare Medicare Advantage plans

WellCare offers several kinds of Medicare Advantage plans, and they vary in terms of structure, costs and benefits available.

In general, WellCare offers Medicare Advantage Prescription Drug Plans, or MAPD, as well as stand-alone Prescription Drug Plans and Medicare Advantage Plans without drug coverage.

Plan offerings include the following types:

HMO plans

A health maintenance organization, or HMO, generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.

HMO-POS plans

HMO point of service, or POS, plans are HMO plans that allow members to get some out-of-network services, but you’ll pay more for those services.

PPO plans

Preferred provider organization, or PPO, plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.

PFFS plans

WellCare’s private fee-for-service, or PFFS, plans allow you to see any Medicare-approved provider who accepts your WellCare plan. You won’t have to pick a primary doctor, and you won’t need a referral to see a specialist.

SNPs

Special needs plans, or SNPs, restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. WellCare offers two types of SNPs:

Chronic Condition SNP: Designed to meet the needs of members living with certain chronic conditions, such as diabetes, congestive heart failure and cardiovascular disorder.
Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.

Available Part D prescription drug plans

While many of WellCare’s Medicare Advantage plans include Part D drug coverage, the company also sells stand-alone Part D prescription drug plans. These plans are meant to accompany Medicare Part A and Medicare Part B and do not provide medical coverage.

WellCare offers drug coverage through the following Prescription Drug Plans, or PDPs:

WellCare Medicare Rx Saver.
WellCare Wellness Rx.
WellCare Classic.
WellCare Value Script.
WellCare Medicare Rx Value Plus.
WellCare Medicare Rx Select.

These plans differ by premium, by the drugs they cover, by the costs associated with each Tier of drugs, and by the pharmacies that are in their network of preferred retailers. To find the best drug plan for you, consider plans that offer the lowest costs for your regular prescriptions and preferred pharmacies.

Additional benefits

WellCare Medicare Advantage offers most MA members access to dental, vision and hearing coverage, unlike Original Medicare. Many of its plans offer other benefits, as well. Here are a few stand-outs:

Flex Card: Depending on your plan and service area, some members may have access to a Visa debit card preloaded with between $200 and $2,500 that they can use to help pay for dental, vision or hearing needs beyond plan coverage.
Over-the-counter benefit: Some plan members may get an allowance they can put toward over-the-counter items like cough and cold meds, first-aid supplies, vitamins and pain relievers.
Fitness benefits: Some plans may cover the cost of an annual membership at a participating health club or fitness center.
Meal delivery: Some plans include free meal delivery through Shipt for a specific number of days with no copay.
Telehealth: Many plans cover telehealth video visits with no copay.

Customer service

WellCare members can contact their plan’s customer service in the following ways:

Send a question via a Contact form.
Call 800-960-2530 with general questions.
Call the member number on your WellCare card.
Visit your WellCare state page (google “WellCare” and your state) and click on Contact Us. This page contains phone numbers for current and prospective Medicare members, as well as a Nurse Advice Line and Behavioral Health Crisis Line, depending on the state.

WellCare service area

WellCare offers Medicare Advantage plans in 27 states, and Medicare prescription drug plans in all 50 states and Washington, D.C. In total, Centene offers Medicare Advantage plans in 1,249 counties [4], or 39% of counties in the U.S.

Centene is the seventh-largest health insurer in the country [5], and it is the fifth largest provider among for-profit health plans. About 1.1 million Medicare beneficiaries are enrolled in a Centene Medicare Advantage plan, and the company added 773,000 new members for the 2021 plan year, both due to the acquisition of WellCare and nearly 200,000 new enrollees.

Cost

Costs for Medicare Advantage plans will depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan’s premium, which ranges from $0 to $156 a month for WellCare’s Medicare Advantage plans. Of WellCare’s HMO, PPO and PFFS plans, about seven out of 10 of them offer a $0 premium [6]. Special Needs Plans have premiums that range from $0 to $31.80, with only about 4% offering $0 premiums [7].

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is at least $148.50 in 2021. (Most people pay this standard amount, but if your income is above a certain threshold, you’ll pay more.)

Other out-of-pocket costs to consider include:

Whether the plan covers any part of your monthly Medicare Part B premium.
The plan’s yearly deductibles and any other deductibles, such as a drug deductible.
Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.
The plan’s in-network and out-of-network out-of-pocket maximums.
Whether your medical providers are in-network or out-of-network, and how often you may go out-of-network for care.
Whether you require extra benefits, and if the plan charges for them.

To get a sense of costs, use Medicare’s Plan Finder to compare information among available plans in your area. You can select by insurance carrier to see only WellCare plans, or compare across carriers. You can also shop directly from WellCare’s website by entering your ZIP code, and you’ll be able to compare the plans available.

Medicare star ratings

Average Star Rating: 3.4

The Centers for Medicare and Medicaid Services maintain their own database of star ratings on every Medicare Advantage and separate Medicare Part D plan, ranging from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

Based on the most recent year of data, WellCare’s Medicare Advantage plans get an average rating of 3.2, and the company’s prescription drug plans (Part D) get an average score of 3.7. The overall average score for WellCare’s plans is 3.4 [8]. For comparison, the average star rating for plans from all providers was 4.06 [9].

Of WellCare’s contracts, the majority are rated 3.5 or 3.0. Only 26% of WellCare’s Medicare Advantage members who are in rated contracts are in contracts with 4 stars or more in 2021 [10]. One Medicare Advantage contract received 4.5 stars, and one contract received 4 stars. No contracts received 5 stars. There were also 29 WellCare contracts that were too new to be measured.

Where did WellCare outperform?

To get an overall star rating, the CMS ranks contracts on 46 different plan factors. WellCare didn’t outperform in many categories, but here are the areas where WellCare plans earned an average score of 4.5 stars (out of 5) and above:

Call center — foreign language interpreter and TTY availability (availability of TTY services and foreign language interpretation when prospective members call the plan).
Appeals upheld (fairness of drug plan’s appeal decisions, based on an independent reviewer).
MPF price accuracy (plan provides accurate Medicare Plan Finder drug pricing information for the website).

Where did WellCare struggle?

WellCare contracts struggled in several categories. Here’s where they averaged a sub-3.0 star score:

Annual flu vaccine (percent of plan members who got a flu shot).
Special Needs Plan care management (percent of members whose plan did an assessment of their health needs and risks in the past year).
Rheumatoid arthritis management (percent of plan members with rheumatoid arthritis who got at least one prescription for an anti-rheumatic drug).
Improving bladder control (percent of plan members with a urine leakage problem in the past six months who discussed treatment options with a provider).
Medication reconciliation post-discharge (the percent of plan members whose medication records were updated within 30 days after leaving the hospital).
Statin therapy for patients with cardiovascular disease ( percent of plan members with heart disease who get the right type of cholesterol-lowering drugs).
Getting needed care (how easy it is for members to get needed care).
Getting appointments and care quickly (how quickly members get appointments and care).
Customer service (how easy it is for members to get information and help from the plan when they need it).
Rating of health care quality (percent of the best possible score the plan earned from members who rated the quality of the care they received).
Rating of health plan (percent of the best possible score the plan earned from members who rated the health plan).
Members choosing to leave the health plan.
Health plan quality improvement (how much the health plan’s performance improved or declined from one year to the next).
Members choosing to leave the drug plan.
Medication adherence for hypertension (percent of plan members taking blood pressure medication as directed).
Medication adherence for cholesterol (percent of plan members taking cholesterol medication as directed).

You can find a plan’s rating with the Medicare Plan Finder.

Third-party ratings

There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included two here:

J.D. Power Ranking: 9th out of 9

In their 2021 U.S. Medicare Advantage Study — the seventh they’ve done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication and billing and payment. On these measures, Centene (which acquired WellCare) scored 769 points out of 1,000 and came in ninth out of the top nine Medicare Advantage providers [11].

NCQA Score Range: 3.5 to 2.5 out of 5

The National Committee for Quality Assurance rates health insurance plans on a 5-point scale (with 5 being best) based on clinical quality, member satisfaction and results from the NCQA Accreditation Survey. The ratings highlight the results of care and what patients say about their care.

The NCQA only has enough data for 12 WellCare plans in their 2019-2020 ratings (there were no ratings in 2020). For those, NCQA awarded ratings between 3.5 to 2.5, with the majority receiving 2.5 ratings [12]. These would be considered lower-performing plans.

Compare alternatives

Compare Medicare Advantage providers
Company	Percent in a 4-star plan or higher	Service area	Average Medicare star rating
Aetna	87%	46 states and Washington, D.C.	3.7
Blue Cross Blue Shield	59%	44 states.	3.8
Humana	93%	50 states, Washington, D.C., and Puerto Rico.	3.7
UnitedHealthcare	76%	50 states and Washington, D.C.	3.9
WellCare	26%	27 states.	3.4

Find the right Medicare Advantage plan

It’s important to do your research before selecting a Medicare Advantage plan for yourself. Here are some questions to consider asking:

What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?
Is your doctor in network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.
Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What Tier are your prescription drugs on, and are there any coverage rules that apply to them?
Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?
Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227, TTY 877-486-2048).

ARTICLE SOURCES:

Works cited

Kaiser Family Foundation, “Medicare Advantage in 2021: Enrollment Update and Key Trends,” accessed June 24, 2021.
Centene, “Centene Completes Acquisition of WellCare,” accessed June 24, 2021.
The Chartis Group, “As Medicare Advantage Enrollment Booms, Healthcare Entities Need to Plan Around Key Trends,” accessed June 24, 2021.
Centene, “Centene Expands Medicare Advantage Offerings for 2021,” accessed June 24, 2021.
Insurance Business America, “Top 10 health insurance companies in the U.S.,” accessed June 24, 2021.
Centers for Medicare & Medicaid Services, “2021 MA Landscape Source Files (v 10 15 20) (ZIP),” accessed June 24, 2021.
Centers for Medicare & Medicaid Services, “2021 SNP Landscape Source Files (v 10 15 20) (ZIP),” accessed June 24, 2021.
Centers for Medicare & Medicaid Services, “2021 Star Ratings Data Table (Oct 08 2020) (ZIP),” accessed June 24, 2021.
Centers for Medicare & Medicaid Services, “2021 Star Ratings Fact Sheet 10 13 2020,” accessed June 24, 2021.
Centers for Medicare and Medicaid Services, “Monthly Enrollment by Contract, 2021-05,” accessed June 24, 2021.
J.D. Power, “Fewer Medicare Advantage Plan Members Actively Managed Their Health during Pandemic, J.D. Power Finds,” accessed June 24, 2021.
NCQA, “NCQA Health Insurance Plan Ratings 2019-2020 - Summary Report (Medicare),” accessed June 24, 2021.

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