We research all brands listed and may earn a fee from our partners. Research and financial considerations may influence how brands are displayed. Not all brands are included. Learn more

WellCare Health Insurance Review

79 Customer Comments & Reviews - see all comments
Our content is free because we may earn a commission when you click or make a purchase using our site. Learn more.
WellCare Health Plans is a health insurance provider that specializes in delivering Medicare and Medicaid services nationwide. The company offers government-sponsored care services to families, individuals, and seniors.

What’s Included with WellCare?

  • Diagnostic tests and imaging
  • Preventive care services
  • Primary care
  • Outpatient surgery
  • Immediate medical attention
  • Prescription drugs
  • Hospitalization
  • Pregnancy care
  • Habilitation and rehabilitation services
  • Mental health, behavioural health, and substance abuse needs
  • Pediatric dental or eye care

Types of Health Insurance Plans

 

Businesses and Organizations

No

Individuals and Families

Yes

Short-Term Health Insurance

Not Stated

Other Plans Offered:

  • Medicare Advantage and PDP Plans

Plans Reviewed

Bronze Plan

  • Out-of-pocket limit: $6,350 per individual and $12,700 per family
  • No overall annual limit on specific services
  • Overall deductibles: $3,000 per person and $6,000 per family
  • A written referral is required to visit a specialist
  • Other covered services: infertility treatment, Chiropractic care, Hearing aid

Silver Plan

  • Out-of-pocket limit: $5,000 per individual and $10,000 per family
  • Overall deductibles: $2,500 per person and $5,000 per family which do not apply to prenatal, postnatal, PCP visits, Tier 1 generic drugs, and Preventive care
  • No annual maximum limit on selected covered services
  • A written referral is required to see a specialist
  • Other covered services: Infertility treatment, Hearing aid, Acupuncture, Dental care for adults, Chiropractic care

Gold Plan

  • Out-of-pocket limit: $4,000 per individual and $8,000 per family
  • Overall deductibles: $600 per person and $1,200per family which excludes prescription drugs
  • No overall annual limit on specific covered services
  • A written referral is required to visit a specialist
  • Other covered services: Hearing aid, Chiropractic care, Infertility treatment

Platinum Plan

  • No overall deductibles for both individuals and families
  • No annual maximum limit for specific covered services
  • Out-of-pocket limit: $2,000 per individual and $4,000 per family
  • A written referral is required to see a specialist
  • Other covered services: Hearing aid, Infertility treatment, Chiropractic care

*Details shown above are for the state of New York

How Much Does It Save You?

 

Bronze

Silver

Gold

Platinum

Services Offered

In-Network

(Your Cost)

Out-of-Network

(Your Cost)

In-Network

(Your Cost)

Out-of-Network

(Your Cost)

In-Network

(Your Cost)

Out-of-Network

(Your Cost)

In-Network

(Your Cost)

Out-of-Network

(Your Cost)

Diagnostic Test

50% after deductible

Not covered

30% after deductible

Not covered

PCP office: $25 co-pay after deductible

Specialist office: $40 co-pay after deductible

 

 

Not covered

PCP office: $15 co-pay after deductible

Specialist office: $35 co-pay after deductible

Not covered

Imaging

50% after deductible

Not covered

30% after deductible

Not covered

$40 co-pay after deductible

Not covered

$35 co-pay

Not covered

Preventive Care Services

Covered in full

Not covered

Covered in full

Not covered

Covered in full

Not covered

Covered in full

Not covered

Primary Care

50% after deductible

Not covered

Visits 1-3: $0 co-pay Visits 4+: 30% deductible

Not covered

$25 co-pay after deductible

Not covered

$15 co-pay

Not covered

Generic Drugs

Retail: $10 co-pay

Mail Order: $25 co-pay after deductible

Not covered

Retail: 30%

Mail Order: 30% after deductible

Not covered

Retail: $10 co-pay

Mail order: $25 co-pay

Not covered

Retail: $10 co-pay

Mail order: $25 co-pay

Not covered

Specialty Drugs

Mail order: $70 co-pay after deductible

Not covered

Mail order: 30% after deductible

Not covered

Mail order: $70 co-pay

Not covered

Mail order: $60 co-pay after deductible

Not covered

Hospital Stay

50% after deductible

Not covered

30% after deductible

Not covered

$100 co-pay after deductible

Not covered

Physician/Surgeon fee: $100 co-pay

Facility fee: $500 co-pay per admit

Not covered

Outpatient Surgery

50% after deductible

Not covered

30% after deductible

Not covered

$100 co-pay after deductible

Not covered

$100 co-pay

Not covered

Urgent Care

50% after deductible

50% after deductible

30% after deductible

30% after deductible

$60 co-pay after deductible

$60 co-pay after deductible

$55 co-pay

$55 co-pay

Emergency Room Services

50% after deductible

50% after deductible

30% after deductible

30% after deductible

$150 co-pay after deductible

Not covered

$100 co-pay

$100 co-pay

Emergency Medical Transportation

50% after deductible

Not covered

30% after deductible

Not covered

$150 co-pay after deductible

Not covered

$100 co-pay

Not covered

Mental/ Behavioral Inpatient Services

50% after deductible

Not covered

30% after deductible

Not covered

$1,000 co-pay per admit after deductible

Not covered

$500 co-pay per admit

Not covered

Mental/ Behavioral Outpatient Services

50% after deductible

Not covered

30% after deductible

Not covered

$25 co-pay after deductible

Not covered

$15 co-pay

Not covered

Substance Use Disorder Inpatient Services

50% after deductible

Not covered

30% after deductible

Not covered

$1,000 co-pay per admin after deductible

Not covered

$500 co-pay per admit

Not covered

Substance Use Disorder Outpatient Services

50% after deductible

Not covered

30% after deductible

Not covered

$25 co-pay after deductible

Not covered

$15 co-pay

Not covered

Prenatal and Postnatal care

Covered in full

Not covered

Covered in full

Not covered

Covered in full

Not covered

Covered in full

Not covered

Pregnancy Delivery and Inpatient Services

50% after deductible

Not covered

30% after deductible

Not covered

$1,000 co-pay per admit after deductible

Not covered

$500 co-pay per admit

Not covered

Rehabilitation and

50% after deductible

Not covered

30% after deductible

50% after deductible

$30 co-pay after deductible

Not covered

$25 co-pay

Not covered

 
Annual Maximum Limit

Bronze

None

Silver

None

Gold

None

Platinum

None

*Only on specific covered services

Summary

WellCare health insurance offers excellent medical services coverage and benefit programs that makes them a good choice for seniors, families, and individuals.

 

 

 

 

 

 

 


Leave a comment for WellCare Health Insurance
Minimum 12 words.
 No maximum length.
* What's Your Rating?
To make this comment as helpful as possible for our community, please provide at least 2 sentences.

79 Customer Comments & Reviews

Loading Reviews ...
E
Eliezer R
1/3/2020
Dale and Gilbert have already expressed all that could be said about this company which, in my view, should not be allowed to operate. Just t is cheap, and "you get what you are paying for". My wife is new to this company. She has been taking a brand Synthroid for almost 10 years, and that what her doctor prescribed her for this pharmacy. Instead, they listed the generic version, and I am waiting the 5th person to resolve the issue for 1hr 33 min - the issue has not yet been resolved. Are we obliged to stay with the company until the end of this year? I Dale Chicago, Illinois 12/27/2019 WellCare, in my opinion, is the worst company for customer service that I have ever dealt... Read More


Caitlin C
12/31/2019
Has failed to pay many of my medical claims despite telling me over the phone it's been taken care of. Just received a bill for nearly 8 thousand dollars for a surgery I needed, got prior authorization for, called and was told everything is authorized, but now 6 weeks later a notice of action arrives stating there was no prior authorization done??? Switched my insurances through the online health marketplace and wellcare refuses to terminate my coverage saying I need to do that through the online health exchange. I did that already. I get hung up on half the time I call in about these issues and nobody has the same information as anybody else. This is by far the worst experience I have... Read More


D
Dale
12/27/2019
WellCare, in my opinion, is the worst company for customer service that I have ever dealt with. It takes at least an hour to actually talk to someone who can ostensibly deal with your question/problem and then, invariably, they are impossible to hear and/or understand their English. A common tactic seems to be to be continually transferred to someone else and then be kept on hold forever or cut off. HORRIBLE customer service. I am sorry that I ever signed up with WellCare.


G
Gilbert S
12/16/2019
Terrible!!! We have made numerous calls to get help and each time we get some person overseas that is extremely difficult to understand and cannot answers our questions and then we are told someone will call back with an answer to our questions and then the same thing repeats, unable to understand the person overseas and no answer to questions. This has been going on since October!!! Oh, my husband just got a call back now at 12:15 am! Save yourself the aggravation and go with another plan. For us, we are stuck with WellCare until next October!


luric50
12/16/2019
After I got a portion of a an email that had no identification I was switched to Wellcare by Aetna because I was late with my payment. I did not ask for this. Aetna let me know that I was disenrolled after the deadline to switch to another company so now it appears that I went from an iffy insurance company to a really bad one. My next move is to see if I have any legal recourse.


C
CC
11/12/2019
I just retired from healthcare after 40 years of service. In my last position I was manager of a quality department for a large pharmaceutical company. I know what quality is and WellCare does not meet that criteria. I notified WellCare of my husband and my change of address. Because of WellCare's process, this could not be done in one phone call and caused me to interact with two different agents - one for my husband and one for me. While attempting to notify WellCare of my change of address, I was disconnected three times. Each time I provided my phone number and asked for a return call in the event I was disconnected. Each time I waited at least 15 minutes before giving... Read More


candscomp
10/19/2019
New customer, I could not get anyone that could not speak ENGLISH good enough to answer my questions. Called a second time and got the same problem. Forget them, I went to Mutual of Omaha Rx. Chipg Green Valley AZ


rlnix970
10/17/2019
I received a letter notifying me that Wellcare will be administering my PDP, which was Aetna/CVS. I made a total of seven phone calls to five different numbers, and the phone would not go thru. I received a message: "Call ended". I finally did reach someone, who was not all that helpful. It is very discouraging to not be able to contact a medical provider immediately.


danyellchavez
10/7/2019
This company is not good at all for long term care it has been over 3 months and my father's ramp is still pending. I am having to get my dad in and out of the house unsafely so that he can get to dialysis. Neglecting their patients in need.


D
Dada Z
9/22/2019
I am on S.S. disabilty, and SSI. I moved to Chicago, Illinois to be closer to my sister. For my medical condition I have to receive an injection every 4 weeks. I called Well Care to make sure my new Dr., and clinic were in their system. Northwest Memorial Hospital. At the start of my call to Well Care, the phone person told me that I had to call my Part A provider to determine if the clinic was in the Well Care system. I explained to this person that is not how it works, as I had to do this two years ago with Well Care. She insisted calling my Part A provider was what i had to do. I told her I needed to speak with her supervisor. When the supervisor got on the phone, I... Read More



Top Rated
Our Partner
  • Get Coverage as soon as Tomorrow!
  • Short term coverage is ideal if you missed enrollment, can't afford traditional insurance, are between jobs, just graduated or retired early.
  • Covers: ER & hospitals coverage, Doctors, Labs, Urgent Care & More
  • Visit any doctor in their nationwide network; no referral required
  • No long term commitment. Budget Friendly.