One of America’s largest health insurance providers, WellPoint Medicare covers 33.6 million individuals in the United States. WellPoint recently merged with Anthem Inc. and Blue Cross and Blue Shield. As a result, the company now provides coverage in all 50 states. Coverage is designed for Americans to get the most affordable plans, with a variety of different coverage options, including HMOs, PPOs and PFFS plans.
One thing that separates WellPoint is the amount of information and educational tips that the company provides for members. Various workshops and programs are provided to help members maintain their health in-between doctor visits. WellPoint has been praised recently for some of its programs, including a health improvement program that targets diabetes. Insured individuals who enroll in this program are 27 percent less likely to go to the hospital than those who are not.
WellPoint has different Medicare Advantage and Medicare supplemental coverage plans. These plans are designed to benefit the individual. But group rates are also provided, to ensure that prices for monthly premiums and annual deductibles stay low. In addition, WellPoint added new prescription drug plans and regional Medicare Part C plans to increase affordability for members.
There are still some issues with WellPoint Medicare’s online system. But the plans have a lot of essential benefits, without hiking up the price.
Overview of WellPoint Medicare Advantage
WellPoint provides Medicare Advantage coverage in all 50 states through Blue Cross and Blue Shield and Anthem. However, you have to navigate to these companies separately in order to find coverage for your state.
Blue Cross and Blue Shield is available in most states. Anthem is only available in select states, including the following:
- New Hampshire
- New York
Going to WellPoint will not point you in the direction of any Medicare plans. Instead, you must go to Anthem.com or BCBS.com to research Medicare Advantage and other supplemental plans available in your area.
Many of the plans provided by WellPoint’s partners contain prevention care, prescription drugs, dental and vision services.
Blue Cross and Blue Shield works with Anthem to provide as many plans as possible across the United States. Working within WellPoint’s network, you get the most with HMO plans and in-network savings.
Getting Medicare with WellPoint
To get Medicare with WellPoint, you must be eligible for Original Medicare or already have Original Medicare. Medicare Advantage or Medicare Part C is available with or without prescription drug coverage.
There are several types of Medicare Advantage plans offered through WellPoint. However, many of these plans are subject to availability in different areas of the United States. Some areas also have larger networks of doctors and hospitals than others. But since the merger with BCBS and Anthem, WellPoint is able to provide more healthcare providers than ever before.
These are the types of Medicare Advantage Plans that might be available in your area:
HMOs (Health Maintenance Organizations) are plans that have predetermined and predictable costs, as long as you stay within your network. You choose a primary care physician and may need a referral to see a specialist. If you decide to go to an out-of-network doctor or hospital, you are responsible for any of those costs.
A PPO (Preferred Provider Organization) is a plan that focuses on networks, but also gives you more flexibility. Patients are able to see doctors outside of the network and go to facilities that are not in the network. However, they may need to pay a higher out-of-pocket cost to do so. These costs are given in each of the plans below. There also is a deductible for out-of-network costs for PPO plans.
Point-of-Service (POS) plans focus on giving customers as much flexibility as they want. They can determine the deductible and out-of-pocket maximum amounts that they will pay for the plan. They may have a higher premium costs than other plans in order to get a lower deductible.
Prescription Drug Plans (PDPs) are stand-alone prescription drug coverage plans that are offered through WellPoint’s partners. These can only be added to Original Medicare to help pay for the costs of prescription medications. These have separate monthly and annual costs.
Mostly, WellPoint provides affordable plans through BCBS or Anthem. Monthly premiums include all of the services that you get with Original Medicare, but you also receive prescription drug coverage. The following section goes over the plans in greater detail.
Benefits and costs of WellPoint Medicare
Most of WellPoint’s Medicare plans will vary by state and region. Service areas may not be eligible for certain plans or costs may be greater. To see which plans you might qualify for, it’s important that you visit Anthem or Blue Cross and Blue Shield for your state.
The online system for finding coverage with these companies utilizes personal information, including ZIP code, age and gender. You may also have to answer questions about your health condition. The following are plans available for someone over the age of 65 living in California.
Benefits included for both WellPoint Medicare Advantage plans are:
- Doctor visits
- Prescription drugs
- Inpatient mental healthcare
- Inpatient hospital care
- Outpatient services
- Skilled nursing facilities
- Home healthcare
- Lab services
- Chiropractic services
- Podiatry services
- Preventive services
- Outpatient mental healthcare
- Outpatient substance abuse care
- Ambulance services
- Emergency care
- Urgent care
- Outpatient rehabilitation services
- Diagnostic tests
- Prosthetic devices
- Dental services
- Hearing services
- Vision services
- Health education and wellness
In some cases, end-stage renal disease (ESRD) is also covered.
Blue Cross and Blue Shield Senior Secure Plan (HMO)
With this HMO plan, you pick a primary care physician who is Medicare-approved.
You can add coverage for dental, vision, hearing and wellness. There’s also a dental and vision supplemental package.
This plan is best for someone who wants predictable coverage, with extras and prescription drug coverage. While you don’t have an annual deductible or monthly premium, you do have a higher copay per visit.
Anthem Medicare Preferred Standard (PPO)
Anthem’s Medicare Preferred Standard is a PPO, which allows you to see both in-network and out-of-network doctors. This plan offers perks if you want coverage for extras, like vision, dental and hearing.
The Anthem plan offers the same supplemental coverage for vision and dental. This provides you with coverage that allows for two oral exams, two teeth cleanings, dental X-rays and preventive dental care. You can also see out-of-network dentists and eye doctors.
Stand-alone WellPoint prescription drug plans
Are you are just looking for prescription drug coverage? WellPoint’s partners have a few different plans that you can add to an Original Medicare plan. Medicare Part D plans pay for just the costs of prescription drugs, including short-term, long-term, brand name, generic, preferred and nonpreferred drugs.
Prescription drug plans available for you will depend on the service area where you live. These are some of the following plans available if you live in California.
Blue Cross MedicareRx Standard (PDP)
For this plan, you pay a monthly premium and pay an annual deductible each year of $310. For preferred generic drugs, you pay $1 at preferred retail locations.
Blue Cross MedicareRx Plus (PDP)
This plan costs requires a higher monthly premium than the Standard plan, but does not include an annual deductible.
For preferred generic drugs, you pay $1 at a preferred retail location. Prices go up if you decide to go to a non-preferred in-network pharmacy or choose mail order.
Blue Cross MedicareRx Gold (PDP)
The Gold plan will bring down your prescriptions drugs costs the most, especially if you are prescribed specialty drugs.
For preferred generic drugs, costs remain low at $1. However, for preferred brand name drugs, you pay just $40 at a preferred retail location. The real benefits are for specialty drugs with this plan. Costs are higher per month for the premium, but if there are specific drugs that you need each month, you won’t have to pay as much for each copay.
WellPoint Medicare Advantage overall rating
Quality score ratings by the Medicare program for WellPoint, Blue Cross and Blue Shield and Anthem are generally favorable. Ratings depend on the region, which means that in some cases, Anthem plans have received lower ratings, such as Texas and Missouri. However, Blue Cross and Blue Shield Plans in New York have received 4 stars or above. You can view plans in your area and look at quality ratings through Medicare.gov.
Both of the plans in this review received over 4 stars. Ratings are based on customer satisfaction, long-term healthcare, customer service, Staying Healthy services, complaints and member experiences.
Overall, WellPoint’s partners offer a variety of different Medicare Advantage plans and supplemental plans, with affordable coverage. The amount of extra services is impressive. And by including additional options for dental and vision, they make it easier for Medicare enrollees to sign up for additional coverage.
The prescription drug packages are also well balanced. They allow enrollees to pick and choose which drugs they need and at what cost to suit their budgets. It’s beneficial that all of the plans include prescription drug coverage, and the deductibles aren’t incredibly high each year.
For Medicare Advantage coverage, it’s clear that WellPoint has largest large network and can provide comprehensive coverage for its members. By merging with Anthem and BCBS, the health provider can offer a large number of network doctors and hospitals, while also keeping plan premiums low.