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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 ...
mudpuppiesla.info
4/17/2020
Since WellCare took over, it has been a nightmare trying to get my medications, most of which I have been on for more than 20 years. I have now been out of one of them for 5 days and have been unable to sleep effectively as a result. This in the midst of the stress of the pandemic situation. Their system of communication and website are abominable and their customer representatives are argumentative and refuse to help in getting an order that has been sitting at a postal facility less than 10 miles from me for three days. Further, they have refused to cover several medications because they "are not on the Medicare formulary." So what is this coverage for if not that? The multiple tiers of... Read More


B
Brenda S
4/15/2020
Hi I would like to understand how you rate wellcare with 4 stars when the reviews are 1 star? I think I picked this horrible insurance company for my 82 yr old mom without looking further based on your your "what has to be bogus reviews Where did this come from are you in the pockets of who you review? I think I'll do some research and see if you have also rated other companies good that have done their customers wrong.


mrt243
4/11/2020
Since going from Aetna to WellCare in January 2020 I have been given two prescriptions. In both cases the prescription was denied as being out of their formulary. I called customer service to enquirer and was on the phone for over 1.5 hours and couldn't hear or understand the customer service reps. I finally gave up. Will definitely cancel at next enrollment period. I would recommend that you avoid using this company if you have any other option.


R
Renee M
3/23/2020
My husband sent Wellcare two electronic funds transfer (ACH payment) for both his drug plan and mine. The payments covered us both for the entire year, through to the end of 2020-- each payment was 158.40. The two separate payments were designated for each of us on the memo line of the ACH payment. However, only one ACH payment was posted - it was to my husband's account. No ACH payment was posted to my account. In fact, Wellcare insists no payment was made to my account. However, my banks has proof that Wellcare deducted two ACH payments from our checking account--One from my husband with his name on it and one from me with my name on it. I repeat, Wellcare only posted one of the... Read More


D
Don
3/16/2020
This review is so wrong. I have Wellcare for prescription drugs. Terrible service. Bad information. Cannot get my prescription because Wellcare gave wrong info on cost. When I call for support hold times after over one hour and then they just hang up. Again - TERRIBLE.


C
Chris K
3/13/2020
I had a difficult time signing up for Wellcare's Electronic Funds Transfer, but I stuck with it and eventually got it done, then yesterday I received a letter stating, "Your enrollment in the program has been cancelled because of the reason specified below: "EFT cancelled per enrollee's request." What??? I worked hard to get enrolled!!! Ugh! I only wish that I could switch to another plan. It's an expensive plan, and the quality is poor.


gwhender
1/13/2020
This health plan company preyed upon my 90 year old mother and a smooth talking sales person got her to sign up for the Well Care plan in place of her great Medicare plan that had worked perfectly for 35 years. When I found out about this, I started to work to un-enroll her from Well Care. This is now like moving heaven and earth. Easy to sign up, difficult to terminate. In the interim, they denied her first claim for wound care. The professionals at Medicare told me there is no reason for her to sign up for Well Care with her good Medicare coverage. I hope to have Well Care terminated soon!! Their telephone agents are not helpful at all.


Paul C
1/7/2020
I have the same experience of all those before. The Customer Service Call Center is in the Philippines and as hard as they may try they have no information to support consumer questions. The Wellcare.com/medicare website is useless and for months announces new site updates. Try filing a claim for a dental procedure or eyeglasses with an out of network provider like Costco ( I have a PPO plan ) there are no forms , no directions and the CS team has no idea . Switched from a Aetna Medicare Advantage Plan and was customer centered. Wellcare doesn't respond to the issue and all calls even online chat tell you to file a grievance that they will respond to in 30 days. I can't imagine the labor... Read More


Patti P
1/6/2020
I tried 12 times to get through to member services. When I finally got through I had used the physician prompt. WellCare ASSIGNED ME A PCP THAT HAD BEEN GONE FOR 2 YEARS! ADDITIONALLY, THEY COULDN'T FIND MY CURRENT DOCTOR IN THEIR SYSTEM. He was on the application and IS THE REASON I WENT WITH WELL CARE!!!! I WAS HOLDING FOR A HALF HOUR FOR THE REP TO GIVE ME OTHER DOCTORS IN NETWORK. WE OF COURSE GOT CUT OFF AND SHE DIDN'T CALL BACK AS I ASKED HER TO THE MULTIPLE TIMES SHE PUT ME ON HOLD!!


L
Leslie
1/3/2020
Their website in inoperative; their hold music is the worst I have ever heard. When I do get a person after long wait time, they don't seem to know their own systems. No one can tell how to change plans/premiums on the website. I received their payment booklet for my new plan, s I know they have my information. It is not up to date on their website. I've already called 4 times today; I get no call backs as promised. They disconnect easily.



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