Wellcare Medicare Insurance Review

Pros Explained

• Low Medicare Advantage premiums: Wellcare offers Medicare Advantage plans with $0 premiums, and it has one of the lowest average premiums among companies we reviewed—$8.71 per month. 
• Variety of plans available: Wellcare offers three options for Medicare Advantage plans: lower-premium HMOs that limit you to in-network providers, and PPO and PFFS plans that come with a higher premium but more choice.

Cons Explained

• Low quality and customer satisfaction ratings: Wellcare received the second-lowest NCQA rating of the companies we reviewed, with an average 3.2 Medicare star rating out of 5 stars. The National Committee for Quality Assurance (NCQA) is an independent organization that rates health plans on factors like patient experience and quality of care. Also, in the J.D. Power 2023 U.S. Medicare Advantage Study, Wellcare’s parent company, Centene, scored below average in nearly every state included in the study. 
• Limited gap coverage: While some prescription drug plans offer additional coverage in the Medicare donut hole, Wellcare’s Part D plans do not. And if you get your drug coverage as part of a Wellcare Medicare Advantage plan, those plans don’t offer drug gap coverage, either. That means you’ll be responsible for 25% of the cost of your covered medications during the gap phase of your plan.

Third-Party Ratings

Wellcare has generally poor third-party ratings when compared to other companies. The Centers for Medicare and Medicaid Services (CMS) gives Wellcare’s MA plans a 2.78 Medicare star rating, which is the lowest among insurers we evaluated. The company notes in its 2023 annual report that it will “...chart a course toward Medicare Stars scores improvement.”

Its Part D plans have a 3-star average rating, also on the lower end. The company’s NCQA rating, which measures patient satisfaction across all Medicare plans, was only 3.2 stars, the second-lowest of the providers we reviewed. 

Wellcare’s parent company, Centene, was also rated below average in almost every state in J.D. Power’s 2023 U.S. Medicare Advantage Study. The company was ranked last for customer satisfaction in four out of the five states studied.

Policies Available

Medicare Advantage (Part C) Plans

Wellcare offers HMO, PPO, and PFFS Medicare Advantage plans. Some plans may include extra perks, including: 

• Preventive dental care
• Hearing and vision services
• Over-the-counter (OTC) medication and wellness benefits
• Fitness memberships and programs
• Transportation services
• Telehealth visits

Many Wellcare plans have $0 primary care copays, and some also offer $0 specialist copays. 

Prescription drug coverage is also available with Wellcare Medicare Advantage plans, and a few plans offer additional coverage for select drugs during the donut hole. 

But other companies on our list of best Medicare Advantage plans offer more plans with additional drug gap coverage, and a better value overall.

Part D Prescription Drug Plans

Wellcare offers several options for prescription drug plans, but none offer additional drug coverage during the gap phase. Other companies on our list of the best Medicare Part D providers also offer plans with better coverage for the price. 

Part D plans are a way to get coverage for your prescription drugs if you have Medicare Part A and/or Part B or a Medicare Advantage plan without prescription drug coverage. Drugs are separated into tiers and listed in a formulary, and each plan has different costs associated with each tier of drugs. 

Medicare Supplement Plans (Medigap)

Medicare Supplement plans help cover the cost of Medicare copays, coinsurance, and deductibles. Medigap plans are offered by private companies, but are standardized and must follow federal and state laws. 

We checked what Medigap plans Wellcare sells in California, Illinois, New York, and Texas. In these states, it sells Medigap plans A, F, G, and N, sometimes as “Wellcare (Centene).” This is a small set of Medicare Supplement options compared to other major insurers, though more plans could be available from Wellcare in other states. In addition, some Centene subsidiaries may offer Medigap plans under a different name, such as Health Net. 

Because of the limited availability, Wellcare was not included on our list of the best Medicare Supplement insurance companies. 

Special Needs Plans

Wellcare also offers special needs plans (SNPs), including Dual Special Needs Plans (D-SNPs) if you qualify for both Medicare and Medicaid. Wellcare’s Chronic Condition Special Needs Plans (C-SNPs) help you manage chronic conditions such as diabetes and cardiovascular disease. Wellcare does not offer Institutional SNPs (I-SNPs).

Cost

Many of Wellcare’s Medicare Advantage plans have $0 primary care copays, and some also offer $0 specialist copays. There are premiums as low as $0, and the company’s average Medicare Advantage premium is the second-lowest of all the major providers we reviewed, at $8.71 per month. 

However, Wellcare’s average drug deductible is $262.55, which is higher than every other provider we reviewed and well above the industry average. The company’s average out-of-pocket expenditure across Medicare Advantage plans is $5,549.83, which is only slightly below the average for the companies we reviewed.

Wellcare’s Part D plans have the lowest average premiums among the providers we reviewed, but they don’t offer additional coverage in the Medicare gap. Companies like Aetna and UnitedHealthcare offer plans with additional coverage in the gap and are also better rated.

Customer Service

You can reach Wellcare by filling out an online form or calling your state-specific customer care line. Select your state at the top right-hand corner of this page to get started. Business hours are generally between 8 a.m. and 8 p.m. local time, seven days per week. You can also chat with a Wellcare member services agent by creating an online account.

How We Review Medicare Providers

To identify which Medicare insurance companies to review, we analyzed business and market insight databases including Statistia, Plunkett, and Gale. We also considered user-generated data from Google to determine public interest and trends in Medicare plans.

We collected data from third-party rating agencies like the credit rating agency AM Best and the National Committee for Quality Assurance (NCQA), an independent organization that rates health insurance plans on quality and customer satisfaction. We also gathered data from government websites and databases provided by the Centers for Medicare and Medicaid Services (CMS) such as CMS.gov and Healthcare.gov, and directly from companies via websites, media contacts, and existing partnerships. The data collection process spanned Sept. 15 to Sept. 29, 2023.

We then developed a quantitative model that scores each Medicare Advantage provider based on four major categories and 22 criteria that are crucial in evaluating the company's offerings and benefits.

We weighted the four categories as follows for this article:

• Plan features: 35%
• Plan quality and customer satisfaction: 30%
• Cost: 20%
• Availability: 15%

Read our full methodology for reviewing Medicare insurance providers.