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WellCare Health Insurance Review

Item: WellCare Health Insurance
Rating: 4.5

80 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.

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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.

80 Customer Comments & Reviews

Loading Reviews ...

William R

4/8/2021

Buyer BEWARE! Customer Service Representatives are NOT empowered to act on your behalf on any issue at WellCare. Unless you enjoy banging your head into a brick wall, AVOID THIS COMPANY!

3/21/2021

Wellcare is the worst-they offer least benefits-every week have fought for medication to be approved and several specialists that i see no longer take them because of all the shenanigans they try to pull. No one has time to constantly fight for approval for the same medication every month. Phone calls are received by reps who don’t have a clue and otc limits you to same 50 overpriced products ($8 for colgate) and otc benefits change randomly from $20 mthly to $35 quarterlywhile my other colleagues have an increase on their otc at us healthcare

Dave

2/26/2021

This company charged a copay for a prescription drug that is more than 7 times the copay's charged by other health insurers. Their copay was more than 3 times the full retail price of the drug at the local major drug store. The drug is a generic that has been around for years. Please check your drug store price before paying this insurer's copay. They should be run out of business.

Doris H

12/31/2020

Enrolled in 2020 coverage Wellcare dividend prime hmo. I do not have any prescriptions so cannot comment on drug coverage. I had one wellness visit. Mainly utilize OTC benefit. Filed multiple grievances online regarding the price, quality, and lack of adequate descriptions of items in the OTC catalog. Obtained permission to purchase OTC items through other vendors and submit copies of receipts for reimbursement. I received the full 480 dollar OTC benefits for the year. I received a Fitbit inspire through silver sneakers. I received 60 dollars in gift cards from healthy rewards. Whenever I had a problem I filed a grievance online and the issue was addressed. When I did not like the answer,... Read More

lawrence k

12/29/2020

Well Care is the worst insurance company I have talked with about Medicare. Their agents are incompetent and poorly trained. All they really did was waste my time. Big promises zero results. I wish I could give zero stars

wurtzchery12

12/29/2020

When I really needed this Plan D the last week of 2020 they were not going to fill my pain medication for 72 hours. Cyclabenzinepine had to be reviewed by Wellcare’s doctor. I had a legal pain prescription for back pain from my doctor to the pharmacy and this had to be reviewed by Wellcare’s doctor. I already had pain through the holiday weekend and WellCare was going to make me wait another 72 hours to review. My premiums had all been paid . Maybe because I shopped the plan D marketplace and of January 1 2021 would be enrolled in another plan D , WellCare was no longer giving service to members in their last week with WellCare. Whatever their reason it left me very doubtful of going... Read More

Stanley

12/27/2020

Trying to get referrals or prescriptions is a joke. Finally bought prescription for my acid reflux. The one they pay for stops absorption of the prescriptions they do pay for. But he real question is if the problem is with my throat and stomach why do they want to put a camera up my butt

junebennett21

11/21/2020

WellCare is the worst health insurance you could buy! No customer service, don't update membership cards when you move to another area. If you move from one area to another you must update your card to your new area or you won't have use of your health insurance card. I asked them 3 times to update my card as I was moving to another area, and they never changed it, so I changed my policy and went to a well known company. They don't know the meaning of "customer service" and ask for your membership number so they can look up your policy, and never get back to you!

Clifford

11/10/2020

I though I did the correct research right up until I tired to register, after signing up for Wellcare. Their website enrollment forms don't compute. Try to talk to a agent and you get inexperienced WelFare Moms with kids in the back ground answering phones. Seem Corporate in now operating by stay at home Agents who don't or can't speak English ,have poor communication equipment at home . Aren't current employees so they can't answer common questions without putting you on hold 5minutes at a time. Back to calling around and find another Medicare D Plan

10/16/2020

The most difficult company to work with if there is a problem. I am a nurse practitioner and I have had both myself and patience have a very difficult time with their customer service department fortunately none of the medical condition has been serious. I would not recommend this company and rather stay or suggest companies that have a long-standing Annie 4 to 5 star rating at Medicare website

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At ConsumersAdvocate.org, we take transparency seriously.

WellCare Health Insurance Review

At ConsumersAdvocate.org, we take transparency seriously.

80 Customer Comments & Reviews

At ConsumersAdvocate.org, we take transparency seriously.

WellCare Health Insurance Review

At ConsumersAdvocate.org, we take transparency seriously.

80 Customer Comments & Reviews

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