WellCare

We worked for many months to secure a new contract with WellCare, but were unable to come to an agreement. Baptist Health hospitals, outpatient clinics, home care and Baptist Health Medical Group practices are out of network with WellCare Medicare Advantage plans as of Jan. 1, 2024.

The most important issue in our discussions with WellCare was to protect your relationship with your physician/clinician and your access to the care you need. We believe your need for medical care should be determined by you and your doctor, not an insurance company.

As part of a Group PPO Plan, KTRS members have what are called "mirror benefits," meaning you can continue to access your Baptist Health providers and services as if you were in-network. Your group plan administrator can provide more information on those benefits.

All Baptist Health hospitals, outpatient clinics, home care and Baptist Health Medical Group practices are out of network with WellCare Medicare Advantage plans as of January 1, 2024.

Your out-of-pocket costs would be significantly higher, even if you were previously approved for temporary Continuity of Care benefits. Going forward, Baptist Health cannot, in good conscience, continue to schedule HMO or Individual PPO plan members for services. Patients already scheduled for services will be cancelled. We will call you to make those arrangements.

If you are experiencing a medical emergency, please go to the nearest emergency room. Insurance companies are required to pay for any emergency services at in-network rates.

If you have a group PPO plan (meaning your Medicare Advantage plan is through an employer or retiree group), you likely have what are called “mirror benefits.” You should be able to continue to access your Baptist Health providers and services as if you were in network. In other words, your out-of-pocket costs should be the same as they were when your plan was in network. Your group plan administrator or employer can provide more information. You can also call the phone number on the back of your insurance card to confirm that you have mirror benefits.

If you do not have “mirror benefits” through a group PPO plan, you may have been eligible for out-of-network coverage through a program called “Continuity of Care.” However, Continuity of Care is short-term, temporary coverage for care for certain types of medical treatments at an out-of-network provider. As such, insurance companies only offer them for 90 days, so any Continuity of Care benefits would have expired at the end of March.

Your ability to continue to access Baptist Health will depend on the type of plan you have.

• Group PPO Plan: If you have a group PPO plan (meaning your Medicare Advantage plan is through an employer or retiree group), you likely have what are called “mirror benefits.” You should be able to continue to access your Baptist Health providers and services as if you were in network. In other words, your out-of-pocket costs should be the same as they were when your plan was in network. Your group plan administrator or employer can provide more information on those benefits.
• Individual PPO plan or HMO plans: Your out-of-pocket costs would be significantly higher, even if you were previously approved for temporary Continuity of Care benefits. Going forward, Baptist Health cannot, in good conscience, continue to schedule HMO or Individual PPO plan members for services. Patients already scheduled for services will be cancelled. We will call you to make those arrangements.
• Exceptions: Baptist Health will schedule you if, during the additional enrollment period that ended March 31, 2024, you changed to a Medicare Advantage plan that is in network with Baptist Health in 2024.

Baptist Health will continue to treat all emergency patients regardless of Medicare Advantage payer or plan type.

The enrollment and plan change opportunities for Medicare Advantage have expired for the 2024 plan year, but you may want to begin thinking about your options for 2025 when the open enrollment period begins again in October 2024. Picking the right Medicare plan is an important decision. Please visit www.medicare.gov to learn about your options.

Baptist Health hospitals, outpatient clinics, home care and Baptist Health Medical Group are out of network for WellCare Medicare Advantage patients as of January 1, 2024. Commercial and Medicaid plan members are not affected.