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Medicare Basics

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Medicare is a federal health insurance program. It is available to people 65 and older, people under 65 with certain disabilities and people with end-stage renal disease. When you are ready to decide on a plan, take the time to understand how the plans work. That way, you can make an informed decision and choose the plan that is right for you.

When It Comes to Coverage, You Have Options

You have the choice of your Medicare coverage. There are two primary options, Original Medicare and Medicare Advantage (also known as Part C).

What are the parts of Medicare?

Original Medicare is a fee-for-service health plan managed by the federal government that has two parts: Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). For drug coverage, you can join a separate Medicare drug plan (Part D).

Learn more about the individual parts of Medicare:

Part A - Hospital Coverage

Helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care

Part B - Medical Coverage

Helps cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds and other equipment)
  • Many preventive services (like screenings, shots/vaccines and yearly "Wellness" visits)

Medicare Advantage (also known as Part C) 

  • An “all in one” alternative to Original Medicare that includes Part A, Part B and, usually, Part D.
  • Plans may have lower out-of-pocket costs than Original Medicare.
  • Most plans offer extra benefits that Original Medicare doesn't cover such as vision, hearing, dental and more.

Part D - Prescription Drug Coverage

Helps cover:

  • Cost of prescription drugs (including many recommended shots and vaccines)

Part D plans are run by private insurance companies that follow rules set by Medicare.

What are Medicare Advantage plans?

A Medicare Advantage Plan is another way to get your Medicare Part A (hospital insurance) and Part B (Medicare insurance) coverage.  Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies that are approved by Medicare.  

If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A and Part B coverage, excluding hospice care.  Most plans also include drug coverage (Part D).  Medicare Advantage plans often offer coverage for things Original Medicare doesn’t cover, such as vision, hearing, dental, and fitness programs (like gym memberships or discounts).

There are different types of Medicare Advantage plans.  The most common types of plans include: 

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)

 

Important Information

For important information about WellCare’s Medicare Advantage coverage including eligibility, benefits and more, please see our Conditions and Limitations page.

You have the right to file a grievance or provide feedback directly to Medicare about our plan. Complete and submit the Medicare Feedback and Complaint Form.

Medicare has an Office of the Medicare Ombudsman (OMO) that can help you with complaints, grievances and information requests. Visit Medicare.gov for more information about Medicare and/or assistance with complaints and grievances.

WellCare Health Plans, Inc., is an HMO, PPO, PFFS plan with a Medicare contract. Our D-SNP Plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

How to access coverage in the event of a disaster or local emergency.

In the event of an emergency or natural disaster, WellCare is committed to helping you continue to access care easily. In a time of crisis, we will:

  • Allow Part A and Part B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities (note that Part A and Part B benefits must, per 42 CFR §422.204(b)(3), be furnished at Medicare certified facilities)
  • Waive in full, requirements for gatekeeper referrals where applicable
  • Temporarily reduce plan-approved out-of-network cost-sharing to in-network cost sharing amounts
  • Waive the 30-day notification requirement to enrollees as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the enrollee
  • Allow you to fill medications sooner than usual to ensure you have what you need during the emergency 

These actions will be in effect through the emergency declaration period. Disasters/Emergencies may be declared by the U.S. Government, the Federal Emergency Management Agency (FEMA), or the Governor of any state.

Typically, the source which declares the disaster will clarify when the disaster or emergency is over. If however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if the Centers for Medicare & Medicaid Services (CMS) has not indicated an end date to the disaster or emergency, we will resume normal operations 30 days from the initial declaration.

WellCare also offers Special Needs Plans (SNP) to qualifying individuals. To enroll in a Special Needs Plan, please contact us for more information.

  • Disclaimers

    For important information about WellCare’s Medicare Advantage coverage including eligibility, benefits and more, please see our Conditions and Limitations page.

    You have the right to file a grievance or provide feedback directly to Medicare about our plan. Complete and submit the Medicare Feedback and Complaint Form.

    Medicare has an Office of the Medicare Ombudsman (OMO) that can help you with complaints, grievances and information requests. Visit Medicare.gov for more information about Medicare and/or assistance with complaints and grievances.

    WellCare Health Plans, Inc., is an HMO, PPO, PFFS plan with a Medicare contract. Our D-SNP Plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

  • How to access coverage in the event of a disaster or local emergency.

    How to access coverage in the event of a disaster or local emergency.

    In the event of an emergency or natural disaster, WellCare is committed to helping you continue to access care easily. In a time of crisis, we will:

    • Allow Part A and Part B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities (note that Part A and Part B benefits must, per 42 CFR §422.204(b)(3), be furnished at Medicare certified facilities)
    • Waive in full, requirements for gatekeeper referrals where applicable
    • Temporarily reduce plan-approved out-of-network cost-sharing to in-network cost sharing amounts
    • Waive the 30-day notification requirement to enrollees as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the enrollee
    • Allow you to fill medications sooner than usual to ensure you have what you need during the emergency 

    These actions will be in effect through the emergency declaration period. Disasters/Emergencies may be declared by the U.S. Government, the Federal Emergency Management Agency (FEMA), or the Governor of any state.

    Typically, the source which declares the disaster will clarify when the disaster or emergency is over. If however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if the Centers for Medicare & Medicaid Services (CMS) has not indicated an end date to the disaster or emergency, we will resume normal operations 30 days from the initial declaration.

  • Special Needs

    WellCare also offers Special Needs Plans (SNP) to qualifying individuals. To enroll in a Special Needs Plan, please contact us for more information.

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Y0070_WCM_64252E Last Updated On: 10/1/2020