Did you know that only 47.2% of U.S. adults received treatment for their mental illness in 2021? Since many mental health resources come with a cost, having access to comprehensive coverage is essential. That’s where Wellcare Medicare comes in.
On the journey to achieve optimal mental well-being, clearly understanding your Wellcare Medicare mental health coverage can make all the difference.
In this article, we’ll explore the key features that set Wellcare Medicare apart from traditional options, what therapy coverage you’re eligible for, how to access information on your coverage plan, how to optimize your therapy services, and more.
Benefits of Wellcare Medicare
What sets Wellcare Medicare apart from other insurance options is its ongoing commitment to providing personalized and comprehensive care management with a holistic approach to health and well-being. Offering benefit-rich advantage plans, Wellcare provides extended flexibility in choosing a healthcare provider that’s right for you.
Here are some standout features:
Dual Eligible Special Needs Plans (D-SNP): Wellcare serves individuals eligible for Medicare and Medicaid, offering integrated care and services to improve access to a wide range of resources and support.
Personalized Care Management: Wellcar offers personalized interventions such as interpersonal therapy (IPT), mindfulness-based therapies (MBSR), and family therapy to meet all Wellcare members’ needs.
Robust Provider Network: A standout feature of Wellcare is their initiative to collaborate with an extensive network of healthcare professionals, including psychiatrists, psychologists, and other mental health professionals, to allow for increased flexibility and options.
Coordinated and Inclusive Services: Beyond traditional Medicare coverage, Wellcare offers more benefits, including dental care, hearing aids, vision benefits, and wellness programs to provide a more holistic approach to members’ health and well-being.
Excellent Customer Service: Wellcare upholds the highest standards in excellent customer service, providing dedicated support to its members and providing a smooth and reliable healthcare journey. Contact a Wellcare support staff member at 1-(888) 550-5252 (TTY members can call 711).
While traditional Medicare provides essential hospital and medical coverage, Wellcare Medicare reaches beyond the basics, offering additional coverage options and a managed care approach.
Mental Health Coverage with Wellcare Medicare
As a leading provider of Medicare Advantage plans, Wellcare provides comprehensive coverage that extends beyond traditional Medicare services — including mental health resources and assistance.
Wellcare serves individuals eligible for Medicare and Medicaid services with specialized dual eligibility options tailored to meet unique medical care needs.
A hallmark of Wellcare’s comprehensive coverage is its extensive focus on behavioral health and mental health services, reflecting a holistic approach to fostering optimal well-being.
Plans include therapy, psychiatric care, and coverage for addressing various mental health conditions such as anxiety, depression, and substance use disorders. Wellcare offers coverage for a range of therapy choices that match personal preferences and needs. These options include cognitive behavioral therapy (CBT), eye movement desensitization reprocessing (EMDR), family therapy, group therapy, one-on-one counseling, and more.
Outpatient vs. Inpatient Mental Health Services
Outpatient services, including individual counseling, allow members to receive mental health support without being admitted into the hospital.
On the other hand, inpatient mental health services, including psychiatric hospitalization, residential treatment, or specific behavioral health issues, involve comprehensive care and around-the-clock monitoring within a specialized healthcare facility. As of January 1, 2021, Wellcare has implemented a policy for short inpatient hospital stays involving ongoing short-term treatment, assessment, and reassessment coverage before discharge.
Telehealth Options
Medicare prioritizes accessibility, accommodating the growing interest in receiving mental health care via video calls or telephone consultations. Telehealth services are an option for members who wish to access therapy services from the comfort of their own homes. This is especially useful for individuals living with mobility challenges or those who are located in remote locations.
Find a telehealth therapist
Navigating Your Wellcare Mental Health Coverage
Understanding and optimizing your mental health coverage is essential to ensure you receive the comprehensive care you need and are eligible for. The first step is to access your coverage information. Follow the reference guide below to navigate your Wellcare Medicare therapy coverage easily.
Step 1: Review Your Policy
Reviewing your Wellcare policy documentation can give you a clearer understanding of the mental health services covered within your insurance plan. You’ll want to pay attention to specific details, including copayments, deductibles, and the number of therapy sessions your plan covers annually.
Step 2: Discover In-Network Providers
In-network providers are any mental health professionals or facilities contracted with Wellcare to offer services at a negotiated rate. Selecting in-network providers can significantly reduce out-of-pocket costs, making your mental health care journey more affordable.
To locate in-network mental health providers in your area, visit the Grow Therapy website and choose your insurance provider and state to view a list of therapists who accept Wellcare.
Find an in-network therapist
Step 3: Understand Out-of-Network Costs
Despite the wide range of in-network providers available across the country, you may require specialized services only available through out-of-network providers.
It’s important to recognize the additional costs, such as providers charging higher fees and higher out-of-pocket expenses per session. In some cases, you may be able to submit a claim for reimbursement from Wellcare.
Step 4: Verify Your Coverage for Specified Services
Different mental health services may require varying levels of coverage within your Wellcare plan. Some services, including psychotherapy or counseling, may be fully covered, while others require copayment or coinsurance.
Before scheduling an appointment with your mental healthcare provider, verify the coverage for the specific service you want to receive.
Step 5: Obtain a Referral, If Necessary
Depending on your Wellcare plan, you may be required to obtain a referral from a primary care physician or other mental health professional, such as a psychiatrist, before accessing specialized services.
It’s best to request a referral before scheduling an appointment with your provider to ensure a smooth flow of treatment and coverage. In some locations, Wellcare HMO plans don’t require a referral to see a specialist.
Step 6: Check for Prior Authorization Requirements
Certain mental health services may require prior authorization from Wellcare before coverage is confirmed. This process ensures that the treatment is medically necessary and eligible for coverage within your Wellcare plan.
Step 7: Keep Track of Your Insurance Usage
Once starting your counseling, therapy, or related mental health sessions, keep track of your utilization to ensure you stay within your plan’s coverage limits. Staying current on the number of your covered therapy sessions and other service limitations can ensure that you manage and optimize your mental health benefits more effectively.
Step 8: Bring Your Wellcare ID Card
You’ll need your Wellcare ID card to access healthcare services covered by your Wellcare Medicare plan. This ID card is proof of your insurance coverage and contains pertinent information to verify your eligibility.
If you’re a caregiver, ensure the person you care for has the necessary support by keeping their WellCare ID card handy for easy access.
Understanding Wellcare Medicare Therapy Costs
As a Wellcare Medicare member, it’s good to have an in-depth understanding of the costs involved with your insurance. Not only can this help you make more informed decisions about your mental health care, it can also help you maximize your benefits.
Costs may include copayments, out-of-pocket expenses, deductibles, and coverage for specific types of therapy.
See how much your therapy will cost
Copayments
Copayments, or copays, are fixed fees that plan members must pay to get specialized therapy services and prescription drugs.
Under your Medicare Advantage plan, members are required to pay copayments for different healthcare services. This can vary depending on the type of therapy, the provider, and the terms of your Wellcare plan.
Out-of-Pocket Expenses
One major benefit of enrollment in a Medicare Advantage plan is cost predictability. These plans set a maximum limit on out-of-pocket expenses for medical services, including counseling or therapy, giving members peace of mind during times of high medical costs.
Deductibles and Coinsurance
Deductibles can vary depending on the specific plan and coverage a member has. Though some plans may have different deductibles, some don’t have any at all. Once a member reaches this amount, their Wellcare plan may start covering a part of the costs — this is known as the coinsurance phase.
During the coinsurance phase, a member is responsible for paying some of the costs, while Wellcare covers the remaining portion.
Access Quality Care Today
With an extensive network of providers and inclusive services, Wellcare offers members access to quality care tailored to their needs. Telehealth options enhance accessibility and convenience, empowering individuals to prioritize their mental well-being no matter where they live.
Ready to take the first step towards a healthier and happier you? Embark on your therapy journey with Grow Therapy today, where you’ll find a diverse selection of expert therapists who accept Wellcare and are ready to guide you on your transformative journey to better mental well-being.
