New Member FAQ

Your new member materials will arrive within the first 30 days of your plan's enrollment date. These materials are mailed to your permanent home address.

Your Member ID card is mailed separately from your health plan materials and is sent to your permanent home address. You should receive your Member ID card within the first 30 days of your plan’s enrollment date.

If you need a copy of your Member ID card or if you’ve misplaced your card, you can access your digital card or print a copy of your card at any time through your secure member portal.

It’s important to have a primary care provider, also called your personal doctor, for when you need care.

You can change your primary care doctor by calling Member Services at the number on the back of your member ID Card. TTY users dial 711. From April 1 - September 30, we're here Monday through Friday from 8 a.m. to 8 p.m. From October 1 - March 31, we're here from 8 a.m. to 8 p.m. 

Or you can change your primary care doctor by going to the homepage of your secure member portal. You can also search for in-network doctors, specialists, and pharmacies in your member portal.

Your Member ID card is the key to receiving the care you need. Because you never know where life might take you, it’s important to keep your card with you at all times. You will need to show your card whenever you visit your pharmacy, doctor’s office, hospital or clinic.

If you have dual Medicare and Medicaid plans or additional insurance, you will need to carry and show all cards as each card serves a unique purpose.

If you think your Member ID card is lost or stolen, please contact Member Services.

If you need a copy of your Member ID card, you can access your digital card or print out a copy of your card at any time through your secure member portal.

You can also request a new Member ID card through your secure member portal or by calling Member Services.

If your plan includes Wellcare Spendables^®, your card is mailed separately from your health plan materials and is sent to your permanent home address.

You should receive your Wellcare Spendables information and card within the first 30 days of your plan’s enrollment date.

Depending on your plan, your dental benefits may include oral exams, cleanings, fluoride treatments, x-rays and emergency services. Some plans also cover dentures.

You can find more information about your benefits, including what exact services are covered by your plan, by checking your Dental Benefits Details, located on your health plan website with your plan documents.

Depending on your plan, your vision benefits may include:

• A yearly routine eye exam
• Glaucoma prevention care
• Diabetic eye exams, also called retinal exams
• Glasses and contacts

You can find more information about your benefits, including what exact services are covered by your plan, by checking your Summary of Benefits, located in the member portal with your plan documents.

Depending on your plan, your hearing benefits may include hearing exams/follow-ups/hearing aids and batteries/and hearing aid fittings.

You can learn more about your benefits, including what exact services are covered by your plan, by checking your Evidence of Coverage. This can be found in your secure Member Portal with your plan documents.

Your Fitness benefit gives you the ability to meet new friends and get active!

You can choose to exercise at local gym or fitness center with group classes or on your own. You can also take live online classes from home, find on-demand videos that can be taken at any time, or have a fitness kit sent directly to your home.

Classes include mobility, yoga, meditation, cardio, strength training, and many more.

You can find your Summary of Benefits by logging in to your secure member portal with your plan documents.

You can find your claims by logging in to your secure member portal. Your claims will show after your provider has submitted the visit or service information to your health plan.

Using an in-network doctor can help you save money. Log in to your secure member portal account to search for in network doctors, specialists, and pharmacies.

Find a Provider

Using an in-network dentist can help you save money. Log in to your secure member portal account to search for in-network doctors, specialists, and pharmacies.

Find a Provider

Using an in-network dentist can help you save money. Log in to your secure member portal account to search for in-network doctors, specialists, and pharmacies.

Find a Provider

An in-network pharmacy is a pharmacy that works with your health plan to provide medications and services to you. Using an in-network pharmacy can help you save on your prescription drug costs.

Using an in-network doctor, pharmacy, or specialist can help you save money. Log in to your secure member portal account to search for in-network doctors, specialists, and pharmacies.

Find a Pharmacy

The formulary, also called a drug list, is a list of brand name and generic prescription drugs that is covered by your health plan. You can find your list of covered drugs by visiting your health plan website.

Over-the-counter products are eligible medications, vitamins and other healthcare items that are available to you without a prescription. Some plans may include coverage for eligible over-the-counter items.

A premium is the monthly amount you may pay for your health plan for your health care and prescription drug coverage. If your plan has a monthly premium, it needs to be paid in order for you to keep your health plan coverage.

Your Primary Care Provider (PCP), also called your personal doctor, is your first stop for getting care. Your doctor is your go-to provider when you aren’t feeling well.

Primary care doctors can diagnose and help you manage medical conditions. They can also write prescriptions and refer you to specialists when you need them.
It’s important to have a primary care provider, also called your personal doctor, for when you need care.

A coinsurance is a percentage of the total cost of a medical service that you need to pay. Coinsurance payments are usually made at the doctor’s office during your appointment or are made to your doctor after they send you a bill.

A copay is a fixed amount that’s you pay for a covered healthcare service. This is usually paid at the time you get the service.

Cost-sharing is what you pay when you get medications or healthcare services.

A deductible is the amount you owe for covered healthcare services before your health insurance plan begins to pay. For example, if your deductible is $200, your plan won’t pay anything until you’ve paid $200 for covered services.

An EOC is a document you receive that gives you details about what the plan covers, how much you pay and more.

An Explanation of Benefits is a statement explaining any treatments or services that you recently received. The Explanation of Benefits usually includes the date(s) of service, provider(s), fees, amounts you may be responsible for and any adjustments.

A prior authorization is an approval from your health plan that may be required before you receive a healthcare service. Your Medicare drug plan may require prior authorization for certain drugs.

Your secure member portal is your one-stop-shop for all your healthcare needs. This secure online account is personalized to you and your plan so you can find care and manage your benefits. You can log on and access the member portal through your internet browser.

Your plan information and materials are in one place, ready anytime and anywhere you need them.

EntryKeyID is an extra level of security to protect your personal information. You will be prompted to create an EntryKeyID account when you create your member portal account. It uses two-step security verification with your email address and a password.

You can register for a portal account by following the steps below:

1. Enter your information
   • Email
   • First and Last Name
   • Member ID number
   • Date of Birth
2. Choose you Language Preference (English or Spanish)
3. Create a secure password

• Find in-network care: Select a primary care doctor or find specialists, pharmacies, and clinics near you.
• View your benefits: See medical and supplemental benefits covered by your plan.
• Access your Member ID card: View or print your digital Member ID card.
• Wellcare Spendables^®: Activate your card, check your balance, shop for eligible products, and more.
• Manage Health To-Dos: Stay up to date on preventive care and easily keep track of screenings, exams, and wellness reminders.
• Prioritize your mental health with Twill: Twill is a free digital platform to support healthy aging and your overall wellbeing through community support, self-guided programs, and interactive activities.
• My WellCare Rewards: Earn points and receive gift card rewards by completing healthy activities.
• Pay your premium: Pay your monthly premium online.

We’re here to answer your health plan questions and get started with your coverage. Call us at the phone number on the back of your member ID card. TTY users dial 711. From October 1 to March 31, we’re here every day from 8 a.m. to 8 p.m. From April 1 to September 30, we’re here Monday through Friday from 8 a.m. to 8 p.m.

Medicare Advantage Plans, also referred to as Part C. Medicare Advantage Plans cover Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). They usually also include Part D, which is Medicare prescription drug coverage. Plans may offer some extra benefits that Original Medicare doesn’t cover.

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.

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.

Yes. However, as long as you are a member of our plan you must use your Member ID card to get covered medical services (with the exception of clinical research studies and hospice services). Keep your Member ID Medicare card in a safe place in case you need it later. If your Member ID card is damaged, lost or stolen, contact us right away, and we will send you a new card.

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.

It can be difficult to know what to do when you aren’t feeling well and need care.

You have many options available to get care including:

• Your Primary Care Provider (PCP), also called your “personal doctor”
• Walk-In Clinics
• Urgent Care Center
• Hospital or Emergency Room
• The 24/7 Nurse Advice Line
• Telehealth and Virtual Care

If your doctor or health care provider would like more information about Wellcare, ask him or her to contact us. Our Member Service Representatives are ready to answer questions.

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.