WellCare vs. Aetna Insurance

With its wide array of health insurance plan structures and highly-praised primary mobile app, Aetna is likely to stand out as a better health insurance company than Wellcare for many prospective policyholders. That said, Wellcare could be an especially attractive option if you are looking for a provider that specializes in Medicare and operates nationwide.

Check out the rest of our Wellcare vs. Aetna insurance comparison below for more details that can help you decide which of the two insurance carriers may be better suited to take care of your health insurance needs. 

Wellcare History

Wellcare was founded in 1985 and specializes in managing government-sponsored health care programs. The company primarily served Medicaid members in the early 2000s but now focuses largely on selling Medicare Part C and D plans.^[1][2] Wellcare was acquired by Centene Corporation in 2020 and took over Centene’s existing Medicare operations in 2022.^[3][2]

Click here to read our full Wellcare review.

Aetna History

Aetna started off selling fire and life insurance policies in the early 1800s and then added health insurance plans toward the turn of the century. The company has made its mark on several notable moments in United States history including writing life insurance policies for the first seven American astronauts in 1963.^[4]

In addition, Aetna boasts several firsts for the United States health insurance industry such as paying out the first Medicare claim in 1966.^[4] Aetna became a part of CVS Health in 2018 following an acquisition worth nearly $80 billion.^[5]

Click here to read our full Aetna review.

Wellcare vs. Aetna: Quick Glance

Wellcare Pros and Cons

Aetna Pros and Cons

Wellcare vs. Aetna: Plan Structures

Aetna can offer coverage to a broader range of customers than Wellcare since it is the only one of the two that offers employer group health insurance, which is the most common type of health coverage in the United States.^[6] 

Wellcare is also limited when it comes to providing private health plans through the Health Insurance Marketplace. Although Wellcare offers Marketplace plans in select states like North Carolina, its parent company, Centene, predominantly sells Marketplace plans through Wellcare’s sister company, Ambetter.^[7][8]

Wellcare vs. Aetna: Plan Availability

Wellcare and Aetna both operate in all 50 states and the District of Columbia.^[9][10] That said, you should keep in mind that these insurers don’t offer all of their coverage types in every state, so you may need to check to see if the type of plan you are looking for is available through either company in your state.

For example, Wellcare sells Medicare prescription drug plans throughout the entire country but only offers Medicare Advantage plans in the following 37 states:^[9]

Wellcare vs. Aetna: In-Network Providers

While neither carrier has shared complete and up-to-date information about the size of its network, Aetna appears to have the edge based on the information that is publicly available. As of 2021, Aetna boasts a sizable network of around 1.2 million total medical providers including more than 5,700 hospitals and more than 700,000 primary care physicians (PCPs) and specialists.^[11]

Wellcare’s network includes over 60,000 pharmacies but the company has not publicly disclosed how large its network is otherwise.^[12] You may want to note that Centene was previously sued and fined for misrepresenting the size of its network to customers who purchased policies through Ambetter.^[13]

Wellcare vs. Aetna: Cost

Health insurance prices heavily depend on your specific circumstances and plan details, so it’s hard to say whether Wellcare or Aetna definitively provides cheaper coverage than the other. For general guidelines on how much you can expect to pay for coverage, keep in mind that Marketplace benchmark health plans cost $477 per month on average in 2024, while the average cost of Medicare Advantage plans that include prescription drug coverage is expected to be $18.50 per month throughout 2024.^[14][15]

Remember that Marketplace health plans can only take these five factors into account when setting your premiums:^[16]

• Age
• Location
• Tobacco use
• Number of people covered by the plan
• Plan tier

Paying attention to the tier system as you shop for Marketplace plans can help you determine how your health care expenses will be divvied up between you and your health insurance company. Bronze and silver plans require you to pay more in copays, coinsurance and deductibles but have lower upfront premiums. Conversely, gold and platinum plans cover a greater portion of the costs when you receive medical services but have higher premiums.^[17]

Wellcare vs. Aetna: Coverage Limits

The maximum amount your insurance company will spend on your health care can vary significantly from plan to plan and even from treatment to treatment within the same plan, meaning there is no easy comparison between Wellcare and Aetna in terms of their coverage limits. Remember that neither company is allowed to set limits on coverage for these 10 essential health benefits:^[18][19]

• Ambulatory patient services
• Emergency services
• Hospitalization
• Pregnancy, maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services (including dental and vision care for children)

Wellcare vs. Aetna: Policy Management

Both Wellcare and Aetna allow members to manage their policies via phone, online account or mobile app. In fact, both insurers have two apps: Wellcare has the general MyWellCare app and the Wellcare+ app for Medicare members, while Aetna has the general Aetna Health app and the Aetna Better Health app for Medicaid members.

The Aetna Health app has excellent reviews on both Google Play and the App Store but ratings for the other apps range from poor to middling. However, this could be attributed in part to the fact that none of the other apps have received nearly as many reviews as Aetna Health.

Wellcare vs. Aetna: Medical Loss Ratio

The Affordable Care Act (ACA) requires health insurance companies to meet a minimum medical loss ratio (MLR) threshold on average on a rolling three-year basis, meaning they must spend a certain percentage of their premium revenues on covering care or otherwise improving the health insurance experience for their policyholders.

The threshold is set at 80% for insurers in the individual and small group health insurance markets and 85% for insurers in the large group health insurance market. Companies that fail to meet these MLR standards are required to issue rebates to their affected policyholders.^[28]

Centene has a three-year rolling average MLR of 87.73% as of the end of 2023, so Wellcare plan members may not be eligible for rebates this year.^[29][30] Conversely, Aetna issued MLR rebates in 14 states plus D.C. in 2023 and, although the company hasn’t formally announced rebates for 2024, a report published by the state of Maine revealed that Aetna expects to pay out $13,970 in MLR rebates to plan members in Maine this year.^[31][32]

Wellcare vs. Anthem: Enrollment Process

If you are interested in signing up for a Marketplace health plan through Wellcare or Anthem, you will generally need to apply during open enrollment between November 1 and January 15 each year.^[33] Alternatively, the following Medicare open enrollment dates apply if you want to enroll in a Medicare Advantage plan:^[34]

However, you can still buy health insurance outside of open enrollment if you qualify for a special enrollment period triggered by a major life event like one of the following:^[35]

• Getting married, divorced or separated
• Giving birth to or adopting a child
• Changing or losing your job
• Moving to a new home
• Losing your existing health coverage due to the death of a family member
• Aging out of your parents’ health plan by turning 26
• Becoming a United States citizen
• Leaving prison 

Wellcare vs. Aetna: Policyholder Experience

Wellcare and Aetna are both rated unfavorably on online review platforms like the Better Business Bureau and ConsumerAffairs. Despite this, Aetna was the best-rated health insurance company in the East South Central, Northwest and Southwest regions in a 2023 J.D. Power study surveying customer satisfaction.^[36]

How To File Claims With Wellcare and Aetna

Wellcare’s online claims portals are primarily reserved for medical providers but, if you need to file your own insurance claim to be reimbursed for medical expenses, you can submit a claim form via email, fax or mail.^[41] Meanwhile, Aetna encourages members to file claims electronically and offers various methods for doing so on its website.^[42] Keep in mind that you shouldn’t need to file a claim yourself if you receive care from an in-network provider since they will generally file a claim on your behalf.