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WellCare Suspends Medicare Advantage Plans in Two States

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Summary: CMS has terminated contracts and imposed sanctions on WellCare Medicare Advantage plans in Arizona and North Carolina due to consecutive low star ratings.  Estimated Read Time: 3 mins

Table of Contents:

  1. WellCare Medicare Advantage Plan Termination in Arizona and North Carolina
  2. What Can WellCare Do Now?
  3. Why is this Important?
  4. Impacts of the WellCare Plan Termination

The Centers for Medicare and Medicaid Services (CMS) has made the decision to halt the sale of two WellCare Medicare Advantage Prescription Drug plans in two states. This decision follows three consecutive years of low star ratings for the carrier in both states.

In addition to terminating the sale of these plans, CMS has also imposed immediate sanctions, ceasing any marketing and enrollment activity. CMS imposed sanctions will be in effect until CMS notifies the carrier that they are satisfied that the reason for the sanctions has been corrected and is unlikely to happen again.

WellCare Medicare Advantage Plan Termination in Arizona and North Carolina

As of January 12, 2024, two WellCare Medicare Advantage Prescription Drug plans are no longer available in Arizona or North Carolina after three years of low satisfaction and star-ratings by enrollees. Due to this, CMS made the decision to immediately halt the marketing and sale of these plans.

According to CMS, for a plan to successfully uphold their contract to sell Medicare Advantage plans, the carrier must obtain at least one three-star rating within the timeframe of three consecutive star-rating periods. WellCare has failed to meet these criteria in 2 of the 27 states it previously offered plans in.

What Can WellCare Do Now?

As the decision stands, WellCare is not able to market, sell, or enroll beneficiaries in either of the Medicare Advantage Prescription Drug plans being terminated and sanctioned in Arizona or North Carolina. However, this decision can be repealed through an appeal process. Centene, who is the parent company of WellCare, has been hard at work trying to increase their Medicare Advantage star ratings. In fact, between 2022 and 2023, the number of Centene beneficiaries enrolled in a four-star or higher plan increased from just 3% to nearly 50%.

If Centene can continue to improve the quality of their plans, the WellCare repeal in these two states does seem likely. However, they will need to prove to CMS their dedication to increasing the quality of the plan for enrollees.

Why is this Important?

The decision to terminate the two WellCare plans in Arizona and North Carolina reiterates the importance for carriers to ensure they are providing quality coverage and service to their enrollees. By imposing sanctions and terminating contracts, CMS is sending a message to other carriers about the importance of regular plan maintenance.

CMS upholding the importance of star ratings ensures all beneficiaries are consistently enrolled in a plan that is suitable for their needs and always hold up to its promises.

Impacts of the WellCare Plan Termination

Individuals who were previously enrolled in the terminated plans in Arizona and North Carolina are now eligible for a Special Enrollment period due to the cancelled contracts. This special enrollment period will last for 1 full month after the contract ends. Thus, it is extremely crucial for you to enroll in a new Medicare Advantage plan as soon as possible to be able to utilize this window.

During this time, you will be eligible to enroll in a new Medicare Advantage plan or return to Original Medicare. Once you have returned to Original Medicare, you have the option to apply for a Medicare Supplement plan if you wish. However, you may still be required to answer underwriting health questions.

If you were previously enrolled in a WellCare Medicare Advantage plan in Arizona or North Carolina, you have likely already received notice of this decision. However, it is important that you utilize your Special Enrollment Period to enroll in new coverage as soon as possible to avoid a lapse in coverage.

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