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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 ...
nickathas777
11/29/2021
The WORST coverage; just read ALL the BAD reviews! Very few doctors accept it, and the ones that do, usually have bad reviews, also! They will talk to you very nice, and waste hours, but with very little results!


marks5844
11/22/2021
Good luck getting any help from Wellcare on your Part D medications coverage plan. Your call is directed to an offshore helpdesk with poor English skills, poor training, and no end-to-end follow through. This has been my consistent experience with this outfit.


P
Patrick F
11/6/2021
My Wellcare Medicare part D drug plan for 2021 has been discontinued a the recommended similar replacement policy is triple the premium. I asked why do much and was told, "well, things do go up." I tried to look at their less expensive plans only to find that each cheaper plan has a higher deductible and a different drug formulary which puts each of my prescriptions in a higher tier resulting in a much higher copay resulting in similar annual out of pocket costs! For the same plan my annual premium was $240 in 2020, $304 in 2021 and will be $828 in 2022. This does not include the cost of the drugs and since my wife has the same insurance these costs are doubled for our family.


savina.milazzo
9/9/2021
Another incident where WellCare denied payment for prescribed medications. Prescribed Meds were for bronchitis. Horrible company. Poor communication when I questioned my situation


rebeccahunter44
8/2/2021
I am a mental health provider. I no longer accept WellCare insurance because they make absolutely everything as difficult as possible - both for me and for my patients. I have never had more trouble with an insurance company, and that is saying a lot. I strongly advise consumers against buying WellCare insurance, no matter how promising their sales pitch sounds.


V
Victor
7/29/2021
WellCare is a synonym for total incompetence and bureaucratic bungling. They botch up simple paperwork, communication with physicians, and outright lie to you about resolving issues that they have unilaterally created. Stay away from this provider if you value your health and well being.


savina.milazzo
6/25/2021
I have WellCare for prescription. In addition to my premiums I am now paying significantly more for my prescriptions. I will disenroll during the open season in October. I warn you to not select this company


Chara S
5/20/2021
All Senior's, if you are considering WellCare, Beware!! We must get the word out! I have been trying to resolve my Sister's (she is 88yr's old) bill for 2 months, which 2 Provider's submitted to WellCare!! When I started 2 months ago, I spoke with wellcare and the agent said that the claim was not submitted properly, excluding a 'preauthorization.' I went back to the Provider's and they resubmitted both Bill's with the 'preauthorization.' I spoke with wellcare again and the agent agreed they would pay it. WRONG!! Both Bill's were denied again!! I was on the phone for an hour the first time and almost 2 hrs. the second time!! The agent's are difficult to understand, they are not... Read More


G
G.J.
5/17/2021
I do not recommend it. As every body else are stating, I do think it is a waste of your time if you try to solve any issue with Wellcare. The Wellcare customer service do not care about the customer's problems. I filed more than 80 grievances in 5 months for the same issue just to request monthly benefits and copayment statement to verify if the copayment bills for Thousands of Dollars I am receiving from an in network providers are legitimate or not, but all the Wellcare answers to my grievances were the same copy and past. They refuse to send monthly benefits and copayment statements, they refused to escalate my case and they refused to verify if the Thousands of Dollars I am... Read More


W
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!



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