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Wellcare Medicare Advantage 2024 Review
Wellcare's Medicare Advantage plans struggle to keep up with other companies' ratings.
Kate Ashford, CSA® Lead Writer | Medicare, retirement, personal finance
Kate Ashford is a writer and NerdWallet authority on Medicare. She is a certified senior advisor (CSA)® and has more than 18 years of experience writing about personal finance. Previously, she was a freelance writer for both consumer and business publications, and her work has been published by the BBC, Forbes, Money, AARP, LearnVest and Parents, among others. She has a degree from the University of Virginia and a master’s degree in journalism from Northwestern’s Medill School of Journalism. Kate has appeared as a Medicare expert on the PennyWise podcast by Lee Enterprises, and she's been quoted in national publications including Healthline, Real Simple and SingleCare. She is based in New York.
Alex Rosenberg Lead Writer | Medicare, health care, legislation
Alex Rosenberg is a NerdWallet writer focusing on Medicare and information technology. He has more than 10 years of experience researching and writing about health care, insurance, technology, data privacy and public policy. His research has supported lawmakers in the Wisconsin State Legislature as well as health systems and national health authorities in the U.S. and more than 10 other countries. He is based in Stoughton, Wisconsin.
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
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CMS Star RatingAverage Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
Wellcare, owned by Centene, offers some nice perks, such as Giveback plans that cover part or all of your Part B premium, but star ratings and member satisfaction fall below other major providers.
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
Low (49% or less)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
2.57 (Below average)
Pros
Company strength: Parent company Centene is the fifth-largest for-profit Medicare Advantage provider.
Some plans include extra benefits such as the Spendables card, which is preloaded with funds members can use on things like over-the-counter products or their share of dental care costs.
Cons
Low star ratings from CMS.
Below-average member experience ratings on things like care coordination and customer service.
States available
37 states
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
Low (49% or less)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
2.57 (Below average)
Pros
Company strength: Parent company Centene is the fifth-largest for-profit Medicare Advantage provider.
Some plans include extra benefits such as the Spendables card, which is preloaded with funds members can use on things like over-the-counter products or their share of dental care costs.
Cons
Low star ratings from CMS.
Below-average member experience ratings on things like care coordination and customer service.
Wellcare is part of Centene Corp., which is the sixth-largest provider of Medicare Advantage plans
. Centene completed its acquisition of Wellcare in early 2020.
Wellcare’s ratings are lower than other providers' numbers. Less than 1% of Wellcare’s members who are in contracts that have a Medicare star rating are in one with a rating of 4 or higher (out of 5) in 2024. And Wellcare’s parent company, Centene, comes in last behind other major providers in four major Medicare markets surveyed by J.D. Power, which weighed metrics like level of trust and the ability to get health services when people want them.
Here’s what you should know about Wellcare Medicare Advantage.
Wellcare Medicare Advantage pros and cons
Wellcare’s Medicare Advantage plans have upsides and downsides.
Pros
Company strength: In 2020, Centene completed its acquisition of Wellcare, and the combined entities claimed 4.4% of the Medicare Advantage market in 2023.
Funds for extra benefits: Some Wellcare plans include the Spendables card, which comes preloaded with funds members can use on over-the-counter items, groceries, rent or utility assistance, gasoline, or dental, vision and hearing benefits, depending on the plan.
Part B premium coverage: Some plans include a Giveback benefit that refunds some or all of your Medicare Part B premium.
Cons
Low star ratings: For 2024, Wellcare’s average star rating from Medicare — weighted by enrollment — is 3.03 stars (out of 5 stars), compared with an overall average among all Medicare Advantage plans of 4.04 stars
The Centers for Medicare & 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.
All Medicare Advantage plans are evaluated on health plan measures, and Medicare Advantage plans that include prescription drug coverage are also evaluated on drug plan measures.
Based on the most recent year of data and weighted by enrollment, Wellcare’s 2024 Medicare Advantage plans get an average rating of 3.03 stars.
For comparison, the average weighted star rating for plans from all providers is 4.04
Only one Wellcare Medicare Advantage contract received 4 stars for 2024, so less than 1% of Wellcare's members in rated contracts are in a contract with 4 stars or more as of October 2023
Costs for Medicare Advantage plans will depend on your plan, your geographic location and your health needs.
Premiums
One of the costs to consider is the plan’s premium. Of Wellcare’s HMO, PPO and PFFS plans in 2024, 3 in 4 offer a $0 premium.
Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is at least $164.90 per month in 2023 ($174.70 in 2024)
Centers for Medicare & Medicaid Services. Costs. Accessed Oct 23, 2023.
. (Most people pay this standard amount, but if your income is above a certain threshold, you’ll pay more.)
Copays, coinsurance and deductibles
Requirements for copays, coinsurance and deductibles vary depending on your plan, location and the services you use. Out-of-pocket costs to consider include:
The plan's deductibles.
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.
Here are some examples of Wellcare Medicare Advantage costs for the most popular plans in a mid-range city:
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.
Wellcare Medicare Advantage plan types
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:
HMO plans
A health maintenance organization (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 (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 (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 (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 (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.
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
In its 2023 U.S. Medicare Advantage Study — the ninth it’s done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on eight factors ranging from level of trust to how well a provider resolves problems or complaints. The study was fielded in the five biggest Medicare markets, and here’s how Centene (which owns Wellcare) ranked out of all major providers in the locations it offers plans
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 2023, the NCQA ranked Wellcare plans between 2.0 and 3.5 stars, with four of the 19 rated plans scoring 3.5 stars. The two plans with 2.0 stars were Western Sky Community Care and Wellcare Health Insurance Company of New Jersey
Wellcare offers Medicare Advantage plans in 37 states, and Medicare prescription drug plans in all 50 states and Washington, D.C.
Centene is the fifth-largest Medicare Advantage provider among for-profit health plans. More than 1.3 million Medicare beneficiaries are enrolled in a Centene Medicare Advantage plan, but the company lost 66,000 members for the 2023 plan year
Wellcare was founded in 1985 and became a subsidiary of Centene in 2020. The company's headquarters are in Tampa, Florida. Wellcare offers coverage through Medicaid, Medicare Advantage and Medicare prescription drug plans. Centene covers more than 1.3 million Medicare Advantage members.
Centene posted total revenues of $144.5 billion in 2022.
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, prescription drug plan members and a Nurse Advice Line, depending on the state.
Compare Medicare Advantage providers
Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.
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).
