Wellcare Medicare Advantage 2022 Review

Wellcare Medicare Advantage is growing in the market, but the provider is falling behind in ratings.

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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 2021 contracts with a Medicare Star Rating are in contracts with a rating of 4 or higher (out of 5). Wellcare’s plans struggle in several 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.

  • Extra benefits for the chronically ill: Some plans include special supplementary benefits for the chronically ill, including food, utility and care concierge benefits.

  • Part B premium coverage: Some plans include a Giveback benefit that refunds some or all of your Medicare Part B premium.

Cons

  • Lower star ratings: For 2022, Wellcare’s average star rating from Medicare is 3.6 stars (out of 5 stars), compared with an overall average among all Medicare Advantage plans of 4.37 stars. Wellcare’s contracts also score poorly on several 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’s footprint has grown by several states in 2022 but still lags behind several other providers. Wellcare offers Medicare Advantage plans in 36 states and Special Needs Plans, or SNPs, in 33 states.

Available Wellcare Medicare Advantage plans

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

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

Plan offerings include the following types:

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 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.

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.

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.

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, which are meant to accompany Medicare Part A and Medicare Part B, don't provide medical coverage.

Wellcare has reduced its stand-alone Medicare prescription drug plan offerings from six to three for 2022 [4]:

  • Wellcare Value Script: Average premium of $11.85; annual drug deductible of $480.

  • Wellcare Classic: Average premium of $30.82; annual drug deductible of $480.

  • Wellcare Medicare Rx Value Plus: Average premium of $68.70. These plans all offer $0-annual drug deductibles.

The specifics of premiums, covered drugs, cost tiers and pharmacies differ by plan and state. You can enter information about your preferred pharmacy and the prescription drugs you take on Wellcare’s website to compare what each plan covers and what you would pay out of pocket each month.

Additional benefits

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

  • 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 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 through a Contact form.

  • Call 800-960-2530 with general questions.

  • Call the member number on your Wellcare card.

  • Visit your Wellcare state page (search “Wellcare” and your state) and select 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 36 states, and Medicare prescription drug plans in all 50 states and Washington, D.C. In total, Centene offers Medicare Advantage plans in 1,575 counties [5], which is almost exactly half of the counties in the U.S.

Centene is tied with a few other companies as the seventh-largest health insurer in the country, and it is the fifth largest provider among for-profit health plans [6]. 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. For 2022, Wellcare Medicare Advantage premiums range from $0 to $286 a month. Of Wellcare’s HMO, PPO, and PFFS plans, about seven out of 10 offer a $0-premium [7]. Special Needs Plans have premiums ranging from $0 to $40.70. Only about 2.3% of Wellcare’s Special Needs Plans offer $0 premiums [8].

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is at least $170.10 in 2022. (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 finding tool 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: 3.6

The Centers for Medicare and Medicaid Services maintains its 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 2022 Medicare Advantage plans (Part C) get an average rating of 3.4, 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 3.6 [9]. For comparison, the average star rating for plans from all providers was 4.37 [10].

Of Wellcare’s contracts, the majority are rated 3.5 or 4.0. Only 26% of Wellcare’s Medicare Advantage members who are in rated contracts are in contracts with 4 stars or more in 2021 [11]. Only three Medicare Advantage contracts received 4.5 stars, and only one received 5 stars. There were also 27 Wellcare contracts that were too new to be measured and 15 more with insufficient data available for scoring by the Centers for Medicare and Medicaid Services.

To get an overall star rating, the CMS ranks contracts on 40 different plan factors. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.) 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:

  • Reviewing appeals decisions.

  • Health plan: Call center — foreign language interpreter and TTY availability.

  • Drug plan: Call center — foreign language interpreter and TTY availability.

  • Medication Therapy Management program completion rate for Comprehensive Medication Review.

Wellcare contracts struggled in several categories. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.) Here’s where they averaged a sub-3.0 star score:

  • Annual flu vaccine.

  • Improving bladder control.

  • Rating of health plan.

  • Monitoring physical activity.

  • Rheumatoid arthritis management.

  • Reducing the risk of falling.

  • Medication reconciliation post-discharge.

  • Rating of health care quality.

You can find a plan’s rating with the Medicare plan finding tool.

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:

In its 2021 U.S. Medicare Advantage Study — the seventh it's 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 [12].

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.

In September 2021, the NCQA ranked Wellcare plans between 2.5 and 3.5 stars, with nine of the 13 rated plans scoring 3.0 stars. The two best scoring plans were Wellcare of California and Wellcare of Florida. Wellcare of South Carolina and Wellcare Health Plans of New Jersey scored the lowest among the rated Wellcare plans [13].

Compare alternatives

See how Medicare Advantage competitors stack up to Wellcare.

Compare Medicare Advantage providers

Company

Percent in a 4-star plan or higher

Service area

Average Medicare star rating (2022)

87%.

46 states and Washington, D.C.

3.8.

Anthem

72%.

24 states and Puerto Rico.

3.9.

59%.

44 states.

4.1.

87%.

26 states and Washington, D.C.

4.2.

93%.

50 states, Washington, D.C. and Puerto Rico.

4.1.

100%.

8 states and Washington, D.C.

5.

76%.

50 states, Washington, D.C., American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

4.2.

26%.

36 states.

3.6.

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 800-MEDICARE (800-633-4227, TTY 877-486-2048).

ARTICLE SOURCES:

  1. Kaiser Family Foundation, “Medicare Advantage in 2021: Enrollment Update and Key Trends,” accessed Oct. 20, 2021.

  2. Centene, “Centene Completes Acquisition of WellCare,” accessed Oct. 21, 2021.

  3. Centers for Medicare & Medicaid Services, “2022 PDP Landscape Source Files (v 09 08 21) (ZIP),” accessed Oct. 20, 2021.

  4. Centene, “Centene Expands Medicare Advantage Offerings for 2022,” accessed Oct. 21, 2021.

  5. Centers for Medicare & Medicaid Services, “2022 MA Landscape Source Files (v 09 08 21) (ZIP),” accessed Oct. 20, 2021.

  6. Centers for Medicare & Medicaid Services, “2022 SNP Landscape Source Files (v 09 08 21) (ZIP),” accessed Oct. 20, 2021.

  7. Centers for Medicare & Medicaid Services, “2022 Star Ratings Data Table (Oct 06 2021) (ZIP),” accessed Oct. 20, 2021.

  8. Centers for Medicare & Medicaid Services, “2022 Star Ratings Fact Sheet_10_8_2021 (PDF),” accessed Oct. 20, 2021.

  9. Centers for Medicare and Medicaid Services, “Monthly Enrollment by Contract, 2021-05,” accessed Oct. 20, 2021.

  10. NCQA, “Health Plans,” accessed Oct. 20, 2021.

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