A: A Medicare Advantage HMO plan is offered by a private company that contracts with Medicare to provide you with all your Medicare Part A (hospital) and Part B (medical) benefits. It is a health maintenance organization, or HMO. That means it provides care through a network of providers. Care is coordinated through the primary care physician (PCP), who may refer people to specialists as needed. Referrals are generally required to see specialists.
Q: What is a Medicare Advantage HMO POS plan?A: A Medicare Advantage HMO POS also provides care through a network of providers. However, it includes a point of service (POS) feature, which allows members to receive health care services outside of the network with authorization from the plan, although use of providers within the network is encouraged.
Q: What is a network?A: A network is a group of doctors and other health care professionals, medical groups, hospitals and other health care facilities that have an agreement with us to deliver covered services to members in our plan. The providers in our network generally bill us directly for care they give you. When you see a network provider, you usually pay only your share of the cost for their services.
Q: Where can I get information about basic Medicare terms?A: We want you to make an informed decision about your Medicare health plan. That’s why we created a glossary located in your state's Medicare Basics page.
Q: Should I still keep my red, white and blue Medicare card?A: Yes. However, as long as you are a member of our plan you must use your Wellcare Member ID Medicare card to get covered medical services (with the exception of clinical research studies and hospice services). Keep Wellcare Member ID Medicare card in a safe place in case you need it later. If your Wellcare ID card is damaged, lost or stolen, Contact Us right away, and we will send you a new card.
Q: If I do not like my Wellcare plan, can I go back to original Medicare?A: Of course. You do not lose your Medicare benefits when you join our plan. However, there are limits on when and how often you can change your Medicare Advantage plan. Contact Us to find out more.
Q: I would like to get my medications (drugs) sent directly to my home. How to I sign-up to receive my prescription drugs and order refills through mail service delivery?A: You can fill your prescription at any network pharmacy. You can also fill your prescription through our preferred mail order service. This can save you time, money, and trips to the pharmacy.
Find more information about receiving your prescriptions through mail service delivery on the following Mail Order Service Page.
Q: How do I get permission to receive services?A: You can get service authorizations from you primary care provider (PCP) or from specialists you're referred to.
Q: Will I have the same coverage as I do with Original Medicare?A: Our plans are required to cover all services and procedures that are covered by Original Medicare. However, our plans also offer extra benefits not covered by Original Medicare, which may include routine dental, routine hearing, routine vision and prescription drug coverage. Please note that, as a member of our plan, your use/participation in a limited number of services, such as clinical research studies and hospice services, will be paid for directly by Medicare. Becoming a member of our plan does not make you ineligible to receive these services.
Q: Can I receive emergency care?A: You have the right to emergency care, when needed, anywhere in the United States and without pre-approval from us.
Q: Do HMO or HMO POS plans cover services that Medicare does not consider medically necessary?A: An HMO or HMO POS plan is not required to pay for services that are not medically necessary under Medicare. However, WellCare plans do pay for additional benefits not covered by Original Medicare. If you receive a service that is not covered by our plan, you are responsible for the cost of that service. If you are not sure whether a service is covered, you have the right to call us and ask for an advance decision.
Q: What do I need to do to get care?A: Our plans work just like a traditional health insurance. Just show your Wellcare Member ID card (instead of your Medicare card) at the doctor's office. You may have a co-payment due at that time.
Q: What happens if my doctor is not familiar with Wellcare Medicare Advantage Plans?A: If your doctor or health care provider would like more information about Wellcare, ask him or her to contact us. Our Customer Service representatives are ready to answer questions.
Q: Can Wellcare ever drop my coverage?A: Once you are enrolled, you cannot be disqualified for any medical condition. However, if you move out of our service area or commit fraud, Wellcare reserves the right to disenroll you. All Medicare Advantage plans commit to their members for a full year. Each year, Wellcare decides whether to continue a plan for another year. Even if a Medicare Advantage Plan is discontinued at the end of a benefit year, you will not lose Medicare coverage. If your plan is discontinued, Wellcare must notify you in writing at least 60 days before your coverage ends. The letter will explain your other options for Medicare coverage in your area.
Q: What if I need to talk to a nurse?A: One of the perks of being a Wellcare member is our 24-hour Nurse Advice Line at 1-800-581-9952. (TTY users dial 711) Our nurses will give you answers to your medical questions and help you decide whether or not to see your doctor or go to the emergency room. Nurses are available 24 hours a day, 7 days a week. You can also find the number on the back of your Member ID card.
Q: Do I still have to pay my Medicare Part B premium?A: Yes. When you join a Wellcare plan, you must continue to pay your Medicare Part B premium unless it's paid for you by Medicaid or another third party. If you meet certain eligibility requirements for both Medicare and Medicaid, your Part B premium may be covered in full. Some of Wellcare's Plans help by reducing your Medicare Part B premium. The reduction is set up by Medicare and administered through the Social Security Administration (SSA). Depending on how you pay your Medicare Part B premium, your reduction may be credited to your Social Security check or credited on your Medicare Part B premium statement. Reductions may take several months to be issued. However, you will receive a full credit.
A: There are five easy ways to enroll. Choose the one that works best for you.
- Enroll online: View our plans and complete your application online.
- Enroll over the phone: Our representatives can enroll you right over the phone. Call 1-877-236-7162, during the hours of 8 a.m. and 2 a.m. EST.
- Enroll at Medicare.gov: Medicare beneficiaries may also enroll in Wellcare through the CMS Medicare Online Enrollment Center located at Medicare.gov.
- Contact a licensed Medicare Sales Broker: They will be able to walk you through different plans and help you select the one that is best for you.
- Enroll by mail or fax: Download, print and complete our enrollment form. Return your completed and signed form to us by fax or mail using the contact information on the form.
A: To search for your medications you can view our online formulary:
- Wellcare Classic Plan
- Wellcare Value Plus Plan
- Wellcare Value Script Plan
If you prefer a copy of the Formulary to be mailed to you, you can request one by calling Member Services at 1-888-550-5252 (TTY: 711) between Oct. 1 and March 31, Monday through Sunday, from 8 a.m. to 8 p.m. or April 1 and Sept. 30, Monday through Friday, from 8 a.m. to 8 p.m. or within the Member Portal by chatting live with an agent at member.wellcare.com.
Q: How can I access a temporary PDP Member ID card?A: Download and print a temporary ID card (PDF) you can use at your pharmacy. If you need to order a new member ID card, please login to the secure Member Portal at member.wellcare.com or call 1-888-550-5252 (TTY 711).
Q: When can I enroll or make a plan change into a prescription drug plan?A: You can join switch or leave a prescription drug plan at these times:
Initial Coverage Election Period
The Medicare Initial Coverage Election Period is based on the month of your 65th birthday. You can enroll as early as three months before your birthday month or as late as three months after your birthday month.
Annual Enrollment Period (AEP)
The Medicare Annual Enrollment Period is from October 15 to December 7, during this time you can:
- Enroll in a Medicare Part D or Medicare Advantage plan from Original Medicare
- Enroll from one Medicare Part D or Medicare Advantage plan to another
- Enroll in original Medicare from a Medicare Advantage Plan
Changes made to coverage during this time would take effect January 1 of the new plan year.
Medicare Advantage Open Enrollment Period (MA OEP)
The Medicare Advantage Open Enrollment Period starts January 1 and ends on March 31. During this period, members enrolled in Medicare Advantage can:
- If you’re in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage)
- You can drop your Medicare Advantage Plan and return to Original Medicare. You will also be able to join a Medicare Prescription Drug Plan.
The effective date for the Medicare Advantage Open Enrollment Period election is the first day of the month after we receive the enrollment request.
Special Enrollment Periods (SEP)
You could qualify for a Special Enrollment Period during any month when certain events happen in your life. Reasons you could qualify include:
- You have changed your permanent residence
- You have recently moved to a new service area
- You want to switch to a plan with a 5-star overall quality rating.
A: Use our helpful Plan Comparison tool. to compare your Wellcare plans options and choose the plan that’s right for you.
With our plan comparison tool, you can review plan details, compare prescription drug costs, and more!
Q: What is a Formulary?A: A formulary lists the drugs your plan covers.
If you are working with a licensed sales representative, he or she will have a copy of the formulary and can help you look up the medications you take. You can also find the formulary online at Wellcare.com/PDP or request a copy by calling the number on the back of your ID card.
Q: What Pharmacies can I use?A: To see preferred and standard pharmacies in our network, please visit our Find a Provider Tool.
A: The Extra Help subsidy helps people who have limited income and resources to pay Medicare prescription drug program costs.
These costs are things like premiums, deductibles and co-payments/co-insurance.
Depending on your income and resources, you may qualify for Extra Help.
Find out if you qualify for Extra Help. Call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week; TTY users may call 1-877-486-2048. Or apply online, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), or contact your state Medicaid Office.
A: There are many ways you can make your premium payment with us.
- Set up AutoPay or make a one-time payment through our secure online member portal.
- Deduction from your Monthly Social Security or Railroad Retirement Board Check
Call Member Services at 1-888-550-5252 (TTY 711) to get more information and set up these deductions. - By Phone: Call 1-888-550-5252 and select the billing option.
- Online Guest Pay: Enter your member ID and email address if you would like a confirmation email. An email address in not required.
- Pay with Cash: Use your member ID or payment coupon to pay with cash at CheckFreePay locations. To find a CheckFreePay location near you, call 1-800-877-8021 or go to checkfreepay.com.
A: A Late Enrollment Penalty (LEP) is an amount added to your Medicare Part D monthly premium.
The cost of the Late Enrollment Penalty depends on how long you went without Part D or creditable prescription drug coverage. Members may owe a Late Enrollment Penalty for any continuous period of 63 days or more after their Initial Enrollment Period is over, or go without one of the following:
- Medicare Prescription Drug Plan (Part D)
- A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage
- Creditable prescription drug coverage (current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, CHAMPVA, or health insurance coverage)
When you enroll in a Part D plan it is important to provide information about prior coverage if you are not enrolling upon turning age 65.
A: Please complete our Become a Provider form or Contact Us for more information on how to join our network. If you want to join our Medicaid provider network, please be sure to visit your state-specific Medicaid website to submit a request.
Q: I forgot my Provider ID number. Where can I find it?A: Please check your Wellcare welcome letter. You can also use the Contact Us form for additional help.
Q: How do I check the status of a claim?A: To check claim status, log into the secure provider portal. The secure portal is for participating Wellcare providers that are contracted through Medicaid or Medicare lines of business.
Here are the steps to check a claim status:
1. Once you log into the secure provider portal, navigate to the Claims landing page.
2. Search for the claim in a variety of ways including: WCN Number, Claim Number, Member ID, Provider ID, Member Name and DOB, Medicare ID, Medicaid ID or DCN.
*Note: Certain items will require that you enter a date range under “Service Date”.
3. Select the “Search” button and the claim results will display below.
A: Yes. Wellcare Health Plans, Inc. is pleased to offer providers electronic funds transfer (EFT) and electronic remittance advice (ERA) services at no charge. Offered in partnership with PaySpan Health, you now have access to a secure, quick way to electronically settle claims. Using this no-cost service, providers can settle claims electronically, without making an investment in expensive EDI software.
You can find additional helpful information in your quick-reference guide.
A: Brokers interested in partnering with Wellcare may contact the Broker Support Call Center at 1-866-822-1339 (TTY 711) for further details.
Q: How do I get information about company health plans?A: To learn more about our combined product offering, what’s new and market-specific benefits, please visit Wellcare First Look.
Q: What If I need additional assistance or have questions?A: Wellcare is here for you! For support, brokers can contact our Broker Support Call Center, submit a Support Ticket online through Centene Workbench, our Single Sign-On broker portal, or reach out to dedicated local support.
Refer to our Sales Leadership Contacts list for local support.
Find additional Wellcare contacts with our Contacts and Resources page.
