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WellCare Health Insurance Review

79 Customer Comments & Reviews - see all comments
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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.

 

 

 

 

 

 

 


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79 Customer Comments & Reviews

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Avi A
12/2/2022
Dont use this Wellcare, it is a scam and offers terrible customer service. They charge more for prescriptions than having no insurance. I tried to pay more for a better plan, the representative said they made the change. Instead, canceled his insurance and left him with no coverage for 2 months


amyderek19
8/22/2022
AVOID THIS COMPANY!!!!!!!!!! For a medicare advantage company this is the absolute worst experience I have ever had. Very difficult to deal with and to try to get authorization for any procedure expect to be on the phone multiple times for at least an hour per call. You have to be the "middleman" between them and your Physician.


Linda T
8/15/2022
HORRIBLE!! I had this plan about 3 years ago. When signing up they make it appear you have great coverage and many doctors to choose from, however when you actually need a doctor it is impossible to get appointments. IF you finally get a doctor and test are ordered WellCare does not approve the services. Getting appointments with specialists if you manage to get appointments you will wait months!! Calling WellCare is useless! There are many plans out there far superior to WellCare... Keep looking you will find better coverage with doctors actually available to see you! FIRST AND FOREMOST REMEMBER ALL THESES "BROKERS" TRYING TO SIGN YOU UP ARE PAID BY INSURANCE COMPANIES FOR EACH... Read More


L
LIsa
6/18/2022
WellCare is an absolute nightmare. My 75 year old mother had perfectly good insurance. Medicare A & B and a secondary from my Father called Champ VA. Last year she was contacted on the phone and bullied into WellCare as a "supplemental Insurance". Well let me tell you, it is anything but. She has been denied coverage by almost every one of her practitioners as well as leaving me, her daughter to provide the funds for prescription overages. I am OUTRAGED that this took the place of her Medicare plan. She did not need any insurance other than what she had. We paid for nothing out of pocket and now I am sitting on hundreds of dollars in bills that she cannot afford and I am not... Read More


susanmarymclean
3/10/2022
I'm angry and disgusted with this company, and the complete lack of knowledge and assistance by the employees that answer the phone. Our dear Mom passed 12-18-21; we and SS / Medicare notified Wellcare of the death. Wellcare took the $69 plus premium 12-20-21, two days after Mom passed. This is Insurance Fraud. Wellcare can't take a premium on a deceased person. I've called at least 4 times; I submitted the POA, the death certificate, and the Representative form they asked for and wrote a letter of grievance. It's now March 10, and I received a rejection letter from the grievance department, along with the same paper to submit yet again. They want a Letter of Appointment of Executor, but... Read More


S
Sandra W
2/25/2022
This company does not post payments in a timely manner. I was told that it takes two weeks to receive a payment and another three days to post. As of today, a payment mailed on February 10th has not posted. This payment was sent by New York State Epic plan to help lower my premium. The two checks thatI sent each took more than two weeks to post. Even after they posted an off shore representative called to tell me that my plan would be canceled as it was in arrears. The off shore representatives barely speak English. When I called today, it took more than 30 minutes to be transferred to someone in this country.


nevermorehaven
2/21/2022
avoid - WellCare is owned by Centene Corp which has been sued multiple times in the last several years for selling junk insurance and defrauding states of Medicaid and Medicare funds by not honoring policies written. (Google it. Stay away.) I am seriously upset and frustrated with Illinois Wellcare Assist HMO. I NEED HELP. First, they are incapable of understanding the seriousness of my issue. Which I will brief below. I have bilateral trigeminal neuralgia. https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Trigeminal-Neuralgia You can google much about the illness, it will all tell you it is the worst pain known to humanity. It is nicknamed the suicide disease.... Read More


E
elise
1/18/2022
Like other reviewers, would leave no stars if I could. The phrase "customer service" is an oxymoron.....there is NO service. Be prepared to spend hours on the phone waiting for a live person; when you finally get to a person be prepared to spend much of it on hold; be prepared to chat with someone who speaks poor English, doesn't care and/or understand what your problem is, and does nothing to solve it. If you have the stamina to make more than one phone call, be prepared to go through your story in it's entirety again......and again. Their drug coverage is a joke. Many drugs can be obtained far cheaper from GoodRx......in which case, why are we required to have Medicare drug... Read More


D
donoliver
1/11/2022
Terrible company to be associate with. Website is totally worthless. Will not look up providers or price drugs. Some drugs not even searchable and I should know because I’m a pharmacist. I will never sign up for this company again. What rating should I give? Since no stars is not an option I’ll give it one half star.


M
M H
12/6/2021
I have had Wellcare health insurance for six months, and I will spend every day of this month desperately seeking another health insurance company. My every interaction with WC has been flat-out dreadful. Their system is WAY too complicated to navigate. There have very few doctors in my town that want to mess with them. (This I learned the hard way. ) The agent lied about this to me to get me to sign up. Also lied about needing referrals. (Good luck trying to figure out the referral system because it makes no sense.) I asked for a case manager and was ignored. The phone lines are a descent into hell. Their phone representatives know little about the system. The only dentist and eye... Read More



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