July 18th 2024
By Ari Parker
Learn about Wellpoint Medicare Advantage plan options, including where they're available, how much they cost, and what benefits are included in coverage.
Wellpoint provides Medicare Advantage plans, Medicare Supplement plans, Medicare Part D prescription drug plans, and Medicaid plans in a limited number of states. In this guide, we’ll go over what types of Medicare Advantage plans it offers, how much these plans can cost in each state, and plan pros and cons.
Wellpoint Medicare Advantage plans have limited availability since you can find them in only six states in 2024.
The cost of Wellpoint Medicare Advantage plans depends on the individual plan and your out-of-pocket costs for healthcare.
Wellpoint offers Medicare Advantage HMO plans and Special Needs plans, but not PPO plans.
Wellpoint received a 3.19 star rating for their Medicare Advantage plans, which is below the industry average of 4.04 in 2024.
Wellpoint Medicare Advantage plans have limited availability across the country. They are available in the following states:
Arizona
Iowa
New Jersey
Tennessee
Texas
Washington
The premiums and out-of-pocket costs of Wellpoint Medicare Advantage plans vary between states and specific plans. Plus, the number of Medicare Advantage insurance plans available to you will depend on the county you live in. Below, we’ve shared plan details for Wellpoint Medicare Advantage plans available in a handful of counties. All copays and coinsurance amounts are for in-network providers.
1 Medicare Advantage plan available: Wellpoint Medicare Advantage (HMO)
$0 premium
$3,000 out-of-pocket maximum
$0 primary copay, $20 specialist copay
2 Medicare Advantage Special Needs Plans available: Wellpoint I Carelon Home Care (HMO I-SNP), Wellpoint I Carelon Home Care 2 (HMO I-SNP)
$0 premium
$2,700-$3,000 out-of-pocket maximum
$0 copays
2 Medicare Advantage Special Needs Plans available: Wellpoint Full Dual Advantage (HMO-POS D-SNP), Wellpoint Dual Advantage (HMO-POS D-SNP)
$0-$27.20 premium
$3,900-$8,850 out-of-pocket maximum
$0-20% primary coinsurance, 20% or $25 specialist coinsurance/copay
1 Medicare Advantage plan available: Wellpoint Medicare Advantage (HMO)
$0 premium
$6,950 out-of-pocket maximum
$5 primary copay, $25 specialist copay
2 Medicare Advantage Special Needs Plans available: Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP), Wellpoint Full Dual Advantage (HMO D-SNP)
$0 premium
$8,850 out-of-pocket maximum
$0 copays
2 Medicare Advantage plan available: Wellpoint Medicare Advantage (HMO-POS), Wellpoint Extra Help (HMO)
$0-$8.60 premium
$4,900-5,500 out-of-pocket maximum
$0 primary copay, $25-$40 specialist copay
2 Medicare Advantage Special Needs Plans available: Wellpoint Full Dual Advantage (HMO D-SNP), Wellpoint Full Dual Advantage Support (HMO D-SNP)
$0 premium
$8,850 out-of-pocket maximum
20% coinsurance for primary and specialist
2 Medicare Advantage plans available: Wellpoint Select (HMO), Wellpoint Medicare Advantage 2 (HMO)
$0 premium
$3,500-$8,300 out-of-pocket maximum
$0 primary copay, $20-$30 specialist copay
8 Medicare Advantage Special Needs Plans available:
Wellpoint Dual Advantage (HMO D-SNP)
Wellpoint Dual Advantage 2 (HMO D-SNP)
Wellpoint Kidney Care (HMO-POS C-SNP)
Wellpoint STAR+PLUS MMP (Medicare-Medicaid Plan)
Wellpoint Full Dual Advantage 2 (HMO D-SNP)
Wellpoint Lung Care (HMO C-SNP)
Wellpoint Chronic Care (HMO C-SNP)
Wellpoint Home Care (HMO I-SNP)
Premiums range from $0-$28.40. Out-of-pocket maximums range from $3,450-$8,850. Copays range from $0-$30.
2 Medicare Advantage Special Needs Plans available: Wellpoint Kidney Care (HMO C-SNP), Wellpoint Dual Advantage (HMO D-SNP)
$0-$29.20 premium
$3,900-$8,850 out-of-pocket maximum
$0 primary copay, $0-$45 specialist copay
Understanding the difference between HMO, PPO, and Special Needs plans will help you better understand the options available to you. Below is a quick breakdown of each.
HMOs (Health Maintenance Organization) and PPOs (Preferred Provider Organizations) both have provider networks. To get the full coverage, you need to see an in-network doctor. With an HMO, you won’t receive any coverage for services from out-of-network providers. With a PPO plan, seeing an out-of-network doctor will cost more.
Wellpoint doesn’t currently offer Medicare Advantage PPO plans.
Special Needs Plans (SNPs) are Medicare Advantage plans that are tailored to the needs of a specific group of people.
There are three types of SNPs:
D-SNPs: for people eligible for both Medicare and Medicaid
C-SNPs: for people who have a chronic condition
I-SNPs: for people who need the level of care provided by an institution
Wellpoint has options for all three types of SNPs. Plan availability varies by county.
Medicare Advantage plans offer additional plan benefits that Original Medicare does not. You can find the following extra plan benefits in some Wellpoint Medicare Advantage plans:
Dental, vision, and hearing coverage
Fitness program membership
Transportation to appointments
Telehealth visits
Over-the-counter (OTC) spending allowance
24/7 nurse line
Wellpoint Medicare Advantage members also have access to the “Essential Extras” benefit. This benefit gives beneficiaries the ability to customize their plans with additional coverage.
With “Essential Extras,” you can choose up to two additional plan benefits, including:
Allowance for assistive and safety devices
Allowance for dental, vision, and hearing needs
Allowance for healthy grocery items and rent/utilities (The benefits mentioned are part of a special supplemental program for the chronically ill. Not all members qualify.)
Transportation
Inclusion of these benefits isn’t guaranteed for every plan, and the spending credit amount varies with every policy.
Compared to other insurance companies, Wellpoint has more options for Special Needs Plans. Its Medicare Advantage plans, however, fall short on CMS star ratings and other factors.
Pros:
Most Wellpoint plans have $0 premiums, low copays, and no deductible
“Essential Extras” gives members the choice to customize their coverage with additional plan benefits
Wellpoint offers Institutional Special Needs Medicare Advantage plans as well as options for Dual-Eligible Special Needs Plans and Chronic Condition Special Needs Plans.
Cons:
Wellpoint Medicare Advantage plans received an average Medicare star rating of 3.19 (below the industry average of 4.04), indicating lower quality plans
Plan availability is limited to only a handful of states
Wellpoint has no PPO plans available
Some competitors offer more additional benefits on more plans for a lower cost
Finding a Medicare plan that works for you is all about focusing on your priorities. Enrollment in a plan may be limited to certain times of the year unless you qualify for a special enrollment period or you are in your Medicare Initial Election Period. Whether you’re looking at Wellpoint Medicare Advantage plans or you want to compare all your options, a licensed Chapter Medicare agent can help you look for a plan that works for your needs.
Call 855-900-2427 TTY 711 Mon-Fri, 9AM to 9PM ET to speak with a licensed agent or schedule a time to chat.
Disclaimers
Currently we represent 43 organizations which offer 16,706 products in your area. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices. This is a solicitation of insurance and not affiliated with the U.S. government or federal Medicare program.
Every year, Medicare evaluates plans based on a 5-star rating system. Anthem-affiliated health plans are Medicare Advantage Organizations and Prescription Drug Plans with a Medicare contract. For Dual-Eligible Special Needs Plans: Anthem affiliated health plans are a DSNP with a Medicare contract and a contract with the state Medicaid program. Enrollment in Anthem-affiliated health plans depends on contract renewal.
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