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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

Loading Reviews ...
henryjohn9652
9/24/2020
at first it was good,at time is passing and i need different testing this compant is refusing mri tests and leaving me in pain for months without knowing what is going on without the testing,the doctors can not help. i hve been left with a limp and no answers. the OTC program was great untill i ordered something twice due to the mobile app not working correctly,not by my own fault,next day i reolized it and tried to correct it by calling them and trying to either cancell this second order or offering to send it back and asking when they recieve it to be credited back,they claim they could not do this and refuse the item back saying i needed to keep it. i do not need two blood pressure... Read More


lamos
9/23/2020
Horrible company- do not use them! I’ve been trying to get an error corrected since June and after commenting on social media they claim they have made the corrections. Hopefully they will pay the $500 in outstanding claims. Their call center is outsourced to another country making communication difficult. You are promised results but they don’t come. ALSO their website has been down for 2 weeks that I am aware of.


R
richard m
9/6/2020
Worst insurance around stay away don't want to pay refuse everything. My medical costs have risen double the savings, will leave them asap


Tom S
7/28/2020
Wellcare Health Insurance is by far the worst insurance I have ever dealt with. Your better off with just with medicare Part A and Part B alone then dealing with all the stupidity aggravation. Don't count on it as being great insurance . They do not cover life in sensual prescribe medical equipment that you depend on for living. Medicare does with no hassles . No matter what health services you need this company will only send you to their doctors. Shoot they wanted to send me to a dead doctor imagine that. Be repaired to miss lots of life saving doctor appointments because of their transportation can't get dates and times straight. This insurance is night mare not only to you as... Read More


graywhitefetch
7/6/2020
Wellcare Medicare Part D insurance is horrible. They gave me low price quotes for drug and then charged me much higher price. My conversations regarding low price quotes were recorded but not noted in my account. Wellcare refused to look for recorded phone conversations because I could not give them dates and times of phone calls and because their people did not note conversations in my account. Most of their representatives speak very poor English and are difficult to understand. Do not use Wellcare. They are dishonest and incompetent.


D
Dave
6/16/2020
This is a horrible plan. No one ever answers the customer service phone line and if you leave a voicemail it is never returned. The majority of providers listed on the site do not accept Wellcare insurance or do not accept new patients. When you finally talk to someone at Wellcare they will also give you providers that do not accept their insurance or who are even retired.


K
Ken K
5/18/2020
I have never seen any company with so many complaints! There is a reason, Hold times can be 1 hour or more! No one you talk to can fix anything! Never get a call back( 2 CSR have been good about call backs) ! That’s out of about 75 CSR. I could write for days about WellCare and the Incompetence that runs deep within! I HAVE WORKED SENCE OCTOBER 2019 to CURRENT MAY 2020 TRYING TO GET COVERAGE ISSUED!THAT IS 8 MONTHS AND STILL CANNOT GET ANYTHING OUT OF THEM! THE ONLY THING THAT WE HAVE BEEN ABLE TO AGREE ON IS THAT MY FILE IS ALL SCREWED UP! BOTTOM LINE- THE ONLY WAY YOU SHOULD TALK TO WELLCARE IS ONLY A VERY LAST RESORT!


D
Dave C
5/16/2020
The customer service of this company is horrible. And their selection of physicians are limited to public, general hospitals - very limited.


M
Marty
4/21/2020
WellCare prescription insurance, dropped the only preferred pharmacy in our area with out notice. The nearest pharmacy is an hour away. Now we have to wait till the first of the year be fore we can change prescription insurance. Totally unprofessional for a company to treat its customers in that way. At least they could of done was wait till the end of the year to drop our local pharmacy. (Snyder's)


cherylw12270
4/19/2020
My brother lives with me due to his disability and has WellCare for his health insurance. This is the worst company I have ever had to deal with. My brother recently got to a point where he could no longer stand up to get to the restroom, take a shower or any other type of self sufficient activities. We both called his PCP to get a referral for assistance. It has taken over a week to get anything accomplished. Every day the insurance company has a different answer such as they cannot find the referral, the referral was cancelled or the correct documents were not submitted. I am much smaller than my brother and for me to change his bedding, bath him, etc...is extremely difficult. Still they... Read More



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