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Q: What is a Medicare Advantage HMO plan?

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'm signed up to get my medications via mail service. How do I order refills?

A: There are three ways to refill:
1. Online. Ordering refills at CVS is convenient, fast and easy! Register online to receive refill reminders and other important updates. Have your Wellcare ID card handy to register.

2. By Phone. Call the toll-free Customer Care number on your prescription label for fully automated refill service. Have your benefit ID number (BIN) ready. This number can be found on your Wellcare ID card.

3. By Mail. You will receive an order form with every mail service order. Simply fill in the ovals for the refills you want to order. If you need a refill for a prescription not listed on the form, write the prescription number in the space provided. Send the form to CVS Caremark along with your payment.

Allow up to 10 days from the day you submit your order for delivery of your medicine. Regular delivery is at no cost to you. Overnight or second-day delivery is available for an additional charge.

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.


Q: How can I enroll in Wellcare?

A: There are five easy ways to enroll. Choose the one that works best for you.

1. Enroll online. View our plans and complete your application online.
2. Enroll over the phone. Our representatives can enroll you right over the phone. 1-877-236-7162, during the hours of 8 am and 2 am EST.
3. Enroll at Medicare beneficiaries may also enroll in Wellcare through the CMS Medicare Online Enrollment Center located at
4. 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.
5. 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.
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Q: When can I enroll or make a plan change into a Prescription Drug Plan?

A: 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 become eligible for Medicaid
  • You qualify for Extra Help with Medicare prescription drug costs
  • You moved to an institution like a skilled nursing facility or long-term care hospital
  • You want to switch to a plan with a 5-star overall quality rating.

Q: How can I compare Wellcare PDP Plans?

A: Please check out our Plan Comparison tool.

Q: Are my prescriptions covered by Wellcare?

A: To search for your medications in our online formulary:

  • Visit
  • Select your state
  • Select "Need a Plan"
  • Select "Prescription Drug Plan"
  • Type in your ZIP code
  • Find your Plan & select “Go to my plan details”
  • On the right side, select Drug List (Formulary) and search for your medications

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, or request a copy by calling the number on the back of your ID card.

Q: What if I am on a limited income or cannot afford my prescription drugs?

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 at, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), or contact your state Medicaid Office.

Q: What Pharmacies can I use?

A: To see preferred and standard pharmacies for your PDP plan, please go to our Find a Provider tool. 

Q: How can I pay my premium?

A: There are many ways you can make your premium payment with us.

1. Set up Auto Pay or make a one-time payment through our secure online member portal.
2. Deduction from your Monthly Social Security or Railroad Retirement Board Check
Call Customer Service (1-888-550-5252) to get more information and set up these deductions.
3. By Phone
Call 1-888-550-5252 and select the billing option.
4Online Guest Pay
Enter your member ID and email address if you would like a confirmation email. An email address in not required.
5. Check or Money Order
Make your check or money order payable to Wellcare and send to:
               Wellcare Health Plans, Inc.
               PO Box 75510
               Chicago, IL 60675-5510
Please ensure you include your member ID on the check or money order.
6. 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

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Q: How do I join Wellcare?

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.

Q: Does Wellcare provide EFT and ERA services?

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.


Q: How do I become a Wellcare broker?

A: Brokers interested in partnering with Wellcare may contact Broker Support Call Center at 866-822-1339 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/Portfolio At A Glance.

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 Broker Portal, or reach out to dedicated local support.

For our local support contacts, contact our Sales Leadership Contacts이 PDF 문서는 새로운 창에서 열립니다.

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Q: How does Wellcare get involved in the local community?

A: Watch the videos and see why we are so passionate about serving our members and the communities in which they live!

Video: A Mission To Serve - Wellcare Health Plans 

Q: How can I find out if Wellcare is hiring?

A: Visit our Careers page to see current openings.

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Y0020_WCM_100876E Last Updated On: 2/10/2023
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