What’s the Difference Between WellCare and Medicare?

Medicare and WellCare are both health insurance programs, but they have some key differences. This article will explain what each program is, how they work, and the main differences between the two.

What is Medicare?

Medicare is a federal health insurance program for people aged 65 and older, as well as some younger people with disabilities. It has several different parts:

• Medicare Part A helps cover inpatient care in hospitals, skilled nursing facilities, hospice, and home health care.
• Medicare Part B helps cover doctor visits, outpatient care, preventive services, and medical equipment.
• Medicare Part C (Medicare Advantage) are private insurance plans that provide all Part A and Part B coverage.
• Medicare Part D helps cover prescription drug costs.

Medicare is administered by the federal government through the Centers for Medicare & Medicaid Services (CMS). Most people get Medicare benefits by paying a monthly premium. You’re eligible for Medicare if you or your spouse worked and paid Medicare taxes for at least 10 years.

Medicare covers many healthcare services, but it does not cover everything. Some key exclusions include long-term care, vision care, dental care, hearing aids, and outpatient prescription drugs (unless you have Part D). Many people purchase supplemental Medigap or Medicare Advantage plans to get more complete coverage.

What is WellCare?

WellCare is a private insurance company that offers Medicare Advantage plans. Medicare Advantage, also known as Medicare Part C, allows private insurers to provide Medicare benefits.

Here’s how it works:

• You must be enrolled in Medicare Parts A and B to join a Medicare Advantage Plan
• Medicare pays WellCare a set amount for your care every month
• WellCare provides all your Part A (hospital) and Part B (medical) coverage
• WellCare Medicare Advantage plans often include Part D prescription drug coverage
• WellCare may offer additional benefits not covered by Medicare

WellCare has been offering Medicare Advantage plans for over 20 years. They have plans in 36 states and cover over 1.2 million members. Their plans come in a few main types:

• HMO plans that use a defined network of doctors and hospitals
• PPO plans that allow you to see out-of-network providers for a higher cost
• Dual eligible special needs plans (D-SNPs) for people who qualify for both Medicare and Medicaid

Some key benefits WellCare offers include:

• $0 premium plans
• Dental, vision, and hearing coverage
• Prescription drug coverage
• Wellness programs
• Transportation benefits

Main Differences Between Medicare and WellCare

While both Medicare and WellCare offer health insurance for seniors, there are some key differences between these two programs:

Administered by Different Entities

• Medicare is a federally-administered, national healthcare program.
• WellCare is a private health insurance company that offers Medicare Advantage plans.

Coverage Differences

• Medicare covers hospital, medical, and prescription drugs (if you enroll in Part D). But it doesn’t cover vision, dental, hearing aids, or long-term care.
• WellCare covers all Medicare Part A and Part B benefits. Their plans often include additional benefits like vision, dental, and hearing coverage.

Out-of-Pocket Costs

• Medicare has deductibles, copays, and coinsurance that can result in unpredictable healthcare spending.
• WellCare Medicare Advantage plans have maximum out-of-pocket limits that cap your annual medical spending.

Provider Networks

• Medicare allows you to see any doctor or hospital that accepts Medicare nationwide.
• WellCare Medicare Advantage plans have defined provider networks. You’ll typically pay more to see out-of-network providers.

Prescription Drug Coverage

• Medicare only covers prescription drugs under Part D plans.
• WellCare includes Part D prescription coverage in many of their Medicare Advantage plans.

Enrollment Eligibility

• Medicare eligibility begins at age 65 for most Americans. You must have at least 10 years of Medicare tax payments to enroll.
• WellCare Medicare Advantage plans require you to be enrolled in Medicare Parts A and B first.

Plan Options

• Medicare offers one national program. You can add supplemental or Part D plans.
• WellCare offers many types of Medicare Advantage plans with differing costs, coverage, and networks.

Choice of Insurers

• Medicare is managed by the federal government. You cannot pick a different government insurer.
• WellCare competes with other private insurers offering Medicare Advantage plans in your area.

Which is Better – Medicare or WellCare?

Whether Medicare or WellCare is better depends on your specific healthcare needs and budget.

Medicare provides solid nationwide coverage at a relatively low cost. But you’ll need to pay deductibles, copays, and coinsurance that can add up. Supplemental plans like Medigap help reduce these out-of-pocket costs.

WellCare Medicare Advantage includes your Medicare benefits along with extras like dental and vision. Maximum annual out-of-pocket limits provide financial protection. But you may be limited to certain doctors and hospitals.

Consider these key factors when deciding between Medicare and WellCare:

• Your healthcare budget and need for low premiums
• Whether your preferred doctors are in-network
• Your need for extra benefits like dental and vision
• Your Medicare eligibility and current health plan enrollment
• Whether you want one nationwide plan (Medicare) or a local plan (WellCare)

Most people stick with Original Medicare and add supplemental coverage as needed. But Medicare Advantage plans like WellCare can provide more benefits and financial predictability for some seniors.

Summary of Main Differences

To recap, here are the main differences between Medicare and WellCare:

<table><thead> <tr> <th>Medicare</th> <th>WellCare</th> </tr> </thead><tbody> <tr> <td>Federal program administered by CMS</td> <td>Private Medicare Advantage plans from insurance company</td> </tr> <tr> <td>Covers hospital, medical, prescriptions (with Part D)</td> <td>Covers Medicare Parts A and B benefits plus may include dental, vision, hearing, etc.</td> </tr> <tr> <td>Higher out-of-pocket costs without supplemental coverage</td> <td>Maximum annual out-of-pocket spending limits</td> </tr> <tr> <td>See any provider nationwide that accepts Medicare</td> <td>Limited to in-network providers, except in PPO plans</td> </tr> <tr> <td>Covers prescriptions under separate Part D plans</td> <td>Most plans include prescription drug coverage</td> </tr> <tr> <td>Eligibility starts at 65 in most cases</td> <td>Must enroll in Medicare Parts A and B first</td> </tr> <tr> <td>One nationwide program with supplemental options</td> <td>Many Medicare Advantage plans to choose from locally</td> </tr></tbody></table>