Wellcare is both a Medicaid and Medicare insurance company
Wellcare operates health insurance plans under both Medicaid and Medicare, so the answer depends on which plan you have with them. Wellcare is a private insurance company that contracts with state Medicaid programs and with the federal Medicare program to provide coverage. You cannot tell which program covers you just by seeing the Wellcare name — you need to look at your actual plan documents or card.
The distinction matters because Medicaid and Medicare are separate federal programs with different rules, covered services, and cost structures. Wellcare simply acts as the middleman that administers the plan on behalf of whichever program you are enrolled in. Your state Medicaid agency or the Centers for Medicare & Medicaid Services (CMS) sets the rules; Wellcare processes your claims and manages your network of doctors.
Key Takeaways
- Wellcare offers plans under both Medicaid (state-run) and Medicare (federal), so you must check your plan documents to know which one you have.
- Your Wellcare member ID card will show whether you are covered under Medicaid or Medicare, usually in small print near the plan name.
- Medicaid Wellcare plans are for people with low income; Medicare Wellcare plans are for people age 65 and older or with certain disabilities.
- The copays, covered services, and doctor networks differ between Medicaid and Medicare Wellcare plans, so knowing which you have affects what you pay and where you can go for care.
How to find out which Wellcare program covers you
The fastest way is to look at your Wellcare member ID card. The card will state either "Medicaid" or "Medicare" somewhere on the front or back. If the card says "Medicaid," your coverage comes from your state's Medicaid program. If it says "Medicare," you are covered under the federal Medicare program. Some cards also list the specific plan name, which often includes the word "Medicaid" or "Medicare" in it.
If you cannot find it on your card, call the customer service number on the back of the card and ask directly. Wellcare's phone line can tell you in seconds whether your plan is Medicaid or Medicare. You can also log into your Wellcare online account if you have one set up — the dashboard usually displays your program type near the top.
Your state Medicaid office or your local Social Security office can also confirm this for you. If you enrolled through your state's Medicaid program, that office has a record of which plan you chose. If you enrolled in Medicare, Social Security or Medicare.gov can pull up your enrollment record.
What Medicaid Wellcare plans cover
Wellcare Medicaid plans cover the services your state's Medicaid program requires, which vary by state. All state Medicaid programs must cover doctor visits, hospital stays, emergency care, and prescription drugs, but the copays and which doctors you can see depend on your specific plan and your state. Some states offer Wellcare plans that also cover dental, vision, or mental health services as part of the same plan.
Medicaid Wellcare plans are for people with low income who meet their state's income and asset limits. You do not pay a monthly premium for Medicaid coverage — the state pays Wellcare to cover you. You may have small copays when you use services, but these are usually low or zero for preventive care.
What Medicare Wellcare plans cover
Wellcare Medicare plans come in two main types: Medicare Advantage (Part C) and Prescription Drug Plans (Part D). A Medicare Advantage plan through Wellcare covers hospital, doctor, and prescription drug services all in one plan, usually with a monthly premium and copays. A Wellcare Prescription Drug Plan covers only medications and is added to Original Medicare (Parts A and B).
Medicare Wellcare plans are for people age 65 and older or people under 65 with certain disabilities who are enrolled in Medicare. You must already be enrolled in Medicare to join a Wellcare Medicare plan. Unlike Medicaid, you pay a monthly premium for Medicare coverage, though the amount varies by plan and your income.
The main differences between Medicaid and Medicare Wellcare
| Feature | Wellcare Medicaid | Wellcare Medicare |
|---|---|---|
| Who it is for | People with low income | People 65+ or with certain disabilities |
| Monthly premium | Usually none | Yes, varies by plan |
| Who runs it | Your state Medicaid program | Federal Medicare program |
| Copays | Usually low or zero | Varies; can be higher |
| Enrollment period | Year-round in most states | October 15 to December 7 each year |
What happens if you have both Medicaid and Medicare
Some people may have access to for both programs — these people are called "dual may be able to access." If you are dual may be able to access and have Wellcare plans under both programs, you will have two separate member ID cards and two separate plans. Wellcare will coordinate between them so that Medicare pays first for most services, and Medicaid covers what Medicare does not.
Some states offer special Wellcare plans designed specifically for dual may be able to access people, which combine both programs into one plan. These are called Dual may be able to access Special Needs Plans (D-SNPs). If your state offers one through Wellcare, it may simplify your coverage by putting both programs in a single plan with one card and one set of rules.
How to contact Wellcare about your plan type
Wellcare's customer service line is on the back of your member ID card. When you call, have your card handy and ask which program your plan is under — Medicaid or Medicare. The representative can also tell you what services are covered, what your copays are, and which doctors are in your network.
You can also visit Wellcare's website, though the site separates Medicaid and Medicare plans into different sections. If you know your state, you can navigate to your state's Medicaid section or the Medicare section to find plan details and contact information specific to your coverage type.
Frequently Asked Questions
Can I switch from Wellcare Medicaid to Wellcare Medicare?
No, these are separate programs based on different may be able to access rules. You switch from Medicaid to Medicare when you turn 65 or when you become may be able to access for Medicare due to disability. At that point, you would need to disenroll from Wellcare Medicaid and enroll in a Wellcare Medicare plan during Medicare's enrollment period.
Does Wellcare Medicaid work in every state?
Wellcare operates Medicaid plans in many states but not all. Your state's Medicaid program decides which insurance companies can offer plans. Check your state's Medicaid website or call your state Medicaid office to see if Wellcare is available in your state and which plans they offer.
What if I lose my Wellcare Medicaid coverage?
If you lose Medicaid coverage, you may be able to enroll in a Wellcare Medicare plan if you are 65 or older, or you may need to find coverage through the health insurance marketplace. Contact your state Medicaid office to understand why your coverage ended and what options are available to you next.
Do I have to use Wellcare doctors if I have a Wellcare plan?
Wellcare plans have a network of doctors and hospitals. You can usually see any doctor in the network without extra cost. If you see a doctor outside the network, you may pay more or the visit may not be covered at all. Check your plan documents or call Wellcare to confirm whether your current doctor is in the network.