WellCare Medicare Insurance Review & Complaints: Health Insurance (2024)

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Florida-based WellCare focuses on government-sponsored health insurance plans including Medicare and Medicaid. They operate through a variety of subsidiary companies across the country.

Our WellCare Medicare review will look at the plans and the coverage that’s included. We’ll also look at WellCare Medicare quotes to help you decide if one of these plans is right for you.

Before you decide if you want to buy WellCare Medicare insurance, take a look at some comparison quotes. Just enter your ZIP code now for free quotes from top companies.

What is WellCare?

WellCare was founded in Tampa Bay, Florida in 1985 for the purpose of writing Medicaid plans for local residents. In 1987, they began offering private Medicare plans as well, initially called Medicare +Choice and later renamed to Medicare Advantage in keeping with legislation. In 2006, they also began offering Medicare Part D plans.

Mainly in 2012 and 2013, WellCare expanded through multiple acquisitions into other states, and their reach now extends to nearly every part of the country. The list of WellCare health plans available varies depending on the state.

WellCare has many subsidiaries across the country, including Ohana, EasyChoice, Harmony, HealthEase, and Staywell. Their headquarters remain in Tampa Bay, with branch offices found in seven other cities.

WellCare came under fire in 2007 due to an FBI investigation of company expenditures. The case resulted in the departure of several top executives and restitution payments to the tune of millions of dollars, but the company insisted that operations and customers were not affected.

The provider continues to offer a range of Medicare plans to customers nationwide.

What WellCare Medicare plan options are there?

WellCare’s health insurance plans differ from state to state, and for the purpose of this review, we selected California, our usual sample state, to look at the company’s offerings. They are all HMO plans, which means you can use only WellCare Medicare providers that are in-network.

What is WellCare Medicare Advantage?

Our sample California ZIP code returned four Medicare Advantage plans. All of the healthcare plans include hearing, vision, and dental.

There are three health plans that have no additional monthly premium beyond the Original Medicare premium. These are Dividend, Best, and Freedom. All of these are HMO plans with no deductible and $0 copays across the board for office visits and specialists. Freedom is an HMO-SNP plan. The Dividend plan is the only one of the three that has an inpatient hospital copay of $125 a day for the first five days.

Each plan also includes some form of prescription drug coverage. There is no prescription deductible and drugs start at $0 for Tier 1 generic drugs, except for the Freedom plan which has a $445 deductible, leaving you responsible for your prescription drug costs until that deductible is met, excluding Tier 1.

The Plus plan is also an HMO, and again has no deductible and no copays for office visits, although there is an $800 a day copay for the first three days of an inpatient hospital stay. There is a prescription deductible of $445 excluding the covered drugs in Tier 1 and prescription coverage copays after that start at $0.

It can be assumed that these different drugs plans require you to use network pharmacies otherwise you could be subject to an additional cost.

What is WellCare Medicare Part D?

There are a number of WellCare Medicare Rx Part D prescription drug coverage plans available from WellCare in our sample area.

One example, Classic, has a drug plan with a $405 deductible that applies to all tiers of coverage. After that, Tier 1 has a $0 copay; Tier 2, $1 and; Tier 3, $32. Tier 4 has a coinsurance amount of 44%, and Tier 5 a coinsurance of 25%.

Extra has no copay or deductible for Tiers 1 and 2. Tier 3 has a copay of $36 and Tiers 4 and 5 have coinsurance amounts of 40% and 33%, respectively.

What are the WellCare Medicare Rates?

As noted above, three of the health plan types do not have an additional cost for a monthly premium beyond what you pay for Original Medicare. The other plan, Plus, costs only $6.70 a month.

The standalone prescription drug plans range in price from $15.20 for the lowest premiums, up to $81 for your monthly premium on the high end.

These rates are specific to the area we sampled them from but, compared to other samples in this area, they are very affordable. It is important to note that these are both HMO plans, which means access is limited to only network providers, including using a retail pharmacy that is part of their pharmacy network. That often means lower rates.

Claims Process at WellCare Medicare Insurance

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

WellCare Medicare offers multiple channels for filing claims, ensuring convenience for policyholders. You can file a claim online through their website, making it a hassle-free process.

Additionally, WellCare provides the option to file claims over the phone, which can be beneficial for those who prefer speaking directly to a representative. Moreover, they offer mobile apps that facilitate the claims submission process, allowing you to manage your claims efficiently from your smartphone or tablet.

Average Claim Processing Time

While WellCare Medicare does not specify its exact claim processing time on its website, most health insurance providers aim to process claims within a reasonable timeframe. The processing time may vary depending on the complexity of the claim and the documentation provided.

It’s advisable to contact WellCare Medicare’s customer service for specific information on claim processing times.

Customer Feedback on Claim Resolutions and Payouts

WellCare Medicare has received mixed customer feedback regarding claim resolutions and payouts. Some policyholders have reported positive experiences with prompt and fair claim resolutions, while others have expressed dissatisfaction with denied claims or delays in processing.

It’s essential to review your policy terms and documentation carefully to ensure a smooth claims process. If you encounter any issues, reaching out to WellCare Medicare’s customer support can help address your concerns.

Digital and Technological Features of WellCare Medicare Insurance

Mobile App Features and Functionality

WellCare Medicare offers a mobile app that provides policyholders with convenient access to their insurance information. The app likely includes features such as the ability to view your policy details, access electronic ID cards, check claims status, and even submit claims directly from your mobile device.

These features enhance the overall customer experience by providing on-the-go access to important insurance-related functions.

Online Account Management Capabilities

WellCare Medicare’s online account management capabilities empower policyholders to take control of their insurance accounts. Through their online portal, you can manage your policy, update personal information, review claims history, and make premium payments securely.

The user-friendly interface ensures a seamless online experience, allowing you to monitor and manage your insurance conveniently.

Digital Tools and Resources

WellCare Medicare likely offers a range of digital tools and resources to assist policyholders in making informed decisions about their coverage. These tools may include online calculators, educational resources, and healthcare provider directories.

By utilizing these digital resources, you can gain a better understanding of your policy and make the most of your WellCare Medicare insurance.

Are the WellCare Medicare reviews and ratings positive?

WellCare has an A+ rating with the Better Business Bureau (BBB) and has 51 complaints on file in the past three years. There are ten customer reviews, most of which complain of poor customer service, with some citing denial of coverage for medications and services.

There are 54 reviews on Consumer Affairs, the majority of which are negative. The complaints are similar to those found on the BBB site — poor customer service claims not being paid.

The National Committee for Quality Assurance ranks each of the WellCare companies independently, and the ratings range from 2.5 stars to 3.5 stars overall. That puts some of them in the below-average range and others a little above average, but none of the companies has a particularly impressive rating.

Finally, the Medicare Ratings for the Easy Choice plans returned on our search were both 3.5 stars. Again, not poor ratings, but not stellar either.

Overall the impression is of a company that has some work to do on customer service and on improving the customer experience to bring up their ratings.

What’s the bottom line?

WellCare’s plans can be inexpensive, but it appears to be a case of getting what you pay for. There are no red flags here, but ratings are mediocre and unimpressive. It would likely be beneficial to shop around for an insurance provider with a plan that fits your budget and provides a higher level of service, with additional benefits that provide you with a better health care experience at a price you can afford. There are companies that offer both a great reputation and also a good value for the dollar.

You may wind up choosing an affordable WellCare Medicare plan, but make sure it’s the best choice first. Compare Medicare quotes right now with our free tool below.