Wellcare Medicare Advantage 2023 Review

Wellcare Medicare Advantage is struggling to keep up with other providers’ ratings.

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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.

Although Wellcare and Centene have joined forces, Wellcare’s ratings are lower than other providers' numbers. Only about half 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 2022. And that number will be even lower in 2023. Wellcare’s plans struggle in many 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 claimed 5.01% of the Medicare Advantage market in 2022

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  • 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, in-home fitness services 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

  • Low star ratings: For 2023, Wellcare’s average star rating from Medicare — weighted by enrollment — is 2.88 stars (out of 5 stars), compared with an overall average among all Medicare Advantage plans of 4.15 stars. Wellcare’s contracts also score poorly on many individual factors, from the percentage of plan members who get a flu shot to how easy it is for members to get help when they need it.

  • 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 lags behind several other providers. Wellcare offers Medicare Advantage plans in 36 states and special needs plans, or SNPs, in 32 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.

Additional benefits

Wellcare Medicare Advantage offers many members access to dental, vision and hearing benefits, 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 $100 and $2,000 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 to members who qualify 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 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, prescription drug plan members and a Nurse Advice 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. The Wellcare brand will offer Medicare Advantage plans in 209 new counties in 2023

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Centene is the fifth-largest Medicare Advantage provider among for-profit health plans. Nearly 1.5 million Medicare beneficiaries are enrolled in a Centene Medicare Advantage plan, and the company added 338,000 new members for the 2022 plan year.

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. Of Wellcare’s HMO, PPO and PFFS plans in 2023, nearly seven out of 10 offer a $0 premium. For plans with a premium, monthly costs range from $6.10 to $232

Centers for Medicare & Medicaid Services. 2023 MA Landscape Source File (v 10 14 2022) (ZIP). Accessed Nov 3, 2022.
. Special needs plans with premiums range from $4.50 to $38.90. About 2% of Wellcare’s special needs plans offer $0 premiums.

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is at least $170.10 per month in 2022 ($164.90 in 2023). (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, weighted by enrollment: 2.88

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 2023 Medicare Advantage plans get an average rating of 2.88 stars

Centers for Medicare & Medicaid Services. 2023 Star Ratings Data Table (ZIP). Accessed Nov 3, 2022.
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For comparison, the average weighted star rating for plans from all providers is 4.15

Centers for Medicare & Medicaid Services. 2023 Medicare Star Ratings Fact Sheet (PDF). Accessed Nov 3, 2022.
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Only 53% of Wellcare’s Medicare Advantage members who are in rated contracts are in contracts with 4 stars or more as of October 2022 — and most of those plans' 2023 ratings are lower

Centers for Medicare & Medicaid Services. Enrollment by Contract, 2022-10. Accessed Nov 3, 2022.
. Only one Medicare Advantage contract received 4 stars for 2023, and all other contracts received lower star ratings. There were also 14 Wellcare contracts that were too new to be measured and 17 more with insufficient data available for scoring by the Centers for Medicare & 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.) NerdWallet measures “outperformance” as earning an average score of 4.5 stars (out of 5) and above. In 2023, Wellcare plans didn’t outperform in any categories.

Wellcare contracts struggled in more than half of categories measured. (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:

  • Colorectal cancer screening.

  • Annual flu vaccine.

  • Monitoring physical activity.

  • Special needs plan care management.

  • Osteoporosis management in women who had a fracture.

  • Diabetes care — eye exam.

  • Diabetes care — blood sugar controlled.

  • Controlling blood pressure.

  • Improving bladder control.

  • Medication reconciliation post-discharge.

  • Health plan: Customer service.

  • Rating of health care quality.

  • Rating of health plan.

  • Complaints about the health plan.

  • Health plan: Members choosing to leave the plan.

  • Health plan quality improvement.

  • Plan makes timely decisions about appeals.

  • Complaints about the drug plan.

  • Drug plan: Members choosing to leave the plan.

  • Drug plan quality improvement.

  • Rating of drug plan.

  • Medication adherence for diabetes medications.

  • Medication adherence for hypertension (RAS antagonists).

  • Medication adherence for cholesterol (statins).

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:

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

In its 2022 U.S. Medicare Advantage Study — the eighth 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 773 points out of 1,000 and came in last out of nine Medicare Advantage providers

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NCQA Score Range: 2.5 to 3.0 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.

In September 2022, the NCQA ranked Wellcare plans between 2.5 and 3.0 stars, with seven of the 10 rated plans scoring 3.0 stars. The three plans with 2.5 stars were WellCare Health Insurance of Arizona in Louisiana, WellCare Health Insurance of North Carolina and WellCare Health Insurance of Arizona.

NCQA. Health Plans. Accessed Nov 3, 2022.
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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.

About Wellcare

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. As of October 2022, Centene covered nearly 1.5 million Medicare Advantage members.

Centene posted total revenues of $126 billion in 2021.

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).
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