WellSense Health Plan Login: Coverage & Benefits Guide

WellSense Health Plan is a nonprofit health insurance company serving over 700,000 members in Massachusetts and New Hampshire. It offers Medicare Advantage (MA) plans, MassHealth Medicaid plans, and Individual & Family (Clarity) plans. Through the WellSense member portal, policyholders can manage coverage, benefits and account details 24/7. In this guide, we explain WellSense coverage and benefits in detail from Medicare Advantage and Medicaid coverage to OTC (over the counter) allowances, provider networks, and customer support. We’ll also cover how to apply for coverage, how to log in to the member portal, and what support is available.

What is WellSense Health Plan?

WellSense Health Plan (formerly Boston Medical Center HealthNet Plan) is a nonprofit insurer offering Medicaid, Medicare Advantage, and individual plans in MA and NH. It was founded over 25 years ago and now covers 700,000+ members through various plan types. WellSense’s mission is to provide affordable coverage and extra support programs “for our members, no matter their circumstances”. Key plan types include:

• Medicare Advantage (MA): Combines hospital (Part A), medical (Part B), and prescription (Part D) coverage in one plan, often with extra benefits like dental, vision, hearing, fitness and OTC allowances.
• MassHealth Medicaid (and NH Medicaid): State sponsored plans for eligible low income individuals and families. WellSense Medicaid offers a statewide provider network and additional member services.
• Individual & Family (Clarity) plans: ACA qualified plans (in MA/New Hampshire branded as Clarity) for people who purchase insurance on their own, with coverage levels and benefits similar to other state plans.

All WellSense plans aim to deliver comprehensive coverage. They typically cover hospital stays, doctor visits, prescription drugs, preventive care (like annual check ups and screenings), and more. Many plans include extras (often called “member perks”) such as gym memberships or rewards programs. In fact, WellSense highlights that members can get support “every step of the way” with enhanced care coordination and extra perks.

Coverage & Benefits WellSense Health Plan

WellSense plans are designed to cover essential health services and extra benefits. While specific coverage depends on the plan (Medicare Advantage, Medicaid, etc.), in general members enjoy:

• Medical coverage: Hospital stays, outpatient care, primary care and specialist visits. Many plans have $0 copays for primary care and low copays for specialist visits. Preventive services (like vaccines and screenings) are often covered at 100% (no cost to member).
• Prescription drugs: Most WellSense plans include prescription drug coverage. Many Medicare Advantage plans have low or $0 deductibles for generic drugs and copays for other medications. Members can fill prescriptions at 1,000+ pharmacies nationwide.
• Dental, vision & hearing: Many plans include no cost preventive dental, vision and hearing benefits. For example, WellSense MA plans provide $0 copays on preventive dental and routine vision/hearing services. Some even cover fillings, crowns, glasses, hearing aids, etc..
• Over the counter (OTC) allowance: A prepaid OTC benefit card is included in most plans, loaded with funds quarterly to buy approved items (see below).
• Fitness programs: WellSense MA plans include the SilverSneakers® fitness program for members 65+, giving access to thousands of gyms and online classes nationwide.
• Care management & support: For members with chronic conditions (diabetes, asthma, etc.), WellSense offers care management programs and nurse hotlines to coordinate care. Members can take health assessments in the portal to get personalized help.
• Extensive provider networks: WellSense maintains large doctor networks. For example, in NH the Delta Dental network has 875+ dentists in state plus national coverage. Both HMO and PPO MA plans have broad networks, and specialists usually do not require referrals. Overall, members have thousands of doctors and providers to choose from in network.

Key benefits of WellSense MA plans include low or $0 premiums and copays, plus rich extras. For instance, members can get $0 monthly premiums on some plans, $0 copays for primary care, $0 drug copays on generics, and $0 preventive dental/vision/hearing. There is also a quarterly allowance on an easy to use OTC card for health and wellness supplies. In addition, WellSense MA members receive dental coverage (with access to Delta Dental’s network) and a SilverSneakers gym benefit.

Medicaid plan members likewise get comprehensive Medicaid covered services (doctor visits, hospital care, prescriptions, etc.), plus extra perks. WellSense emphasizes a “statewide provider network, enhanced care coordination and extra member perks” for Medicaid members. These can include things like ride services to appointments, rewards for completing health surveys, and other wellness incentives.

Medicare Advantage Coverage (WellSense MA)

WellSense’s Medicare Advantage (MA) plans combine Medicare Part A, B and D benefits in one HMO or PPO plan. Key features:

• Comprehensive care: Hospital, medical and prescription drug coverage, plus no cost preventive care. Members keep all the traditional Medicare benefits with additional extras.
• Extra benefits: WellSense MA plans add benefits like dental, vision, hearing and an OTC card. For example, the plan list shows “$0 preventive dental, vision and hearing copays”, meaning routine cleanings, exams, and hearing checks can be free.
• $0 or low costs: Many MA plans have $0 premiums and copays. WellSense advertises “monthly premiums as low as $0”, $0 copays for primary care, and $0 copays on many preferred generic drugs.
• OTC benefit: MA members get an InComm OTC card loaded quarterly (Jan/Apr/Jul/Oct) for items like first aid supplies, vitamins, and personal care. For example, one plan offers $275 per quarter on the card (up to $1,100 per year).
• Fitness & health programs: SilverSneakers gym membership is included, giving free access to 15,000+ fitness locations nationwide. There is also a post hospital meal delivery benefit (up to 28 meals) and personalized care management programs.

Benefits snapshot: WellSense MA members enjoy zero dollar primary care visits, specialist copays, drug deductibles, and preventive services. They also get $0 generic drug copays and allowances for OTC items. Combined with dental/vision/hearing coverage and fitness benefits, these extras make WellSense MA plans appealing for eligible seniors.

Medicaid Coverage WellSense Health Plan

WellSense serves Medicaid eligible residents under state programs (MassHealth in MA and NH Medicaid). Like all Medicaid managed care, members receive:

• Full Medicaid covered benefits: Doctor visits, hospital care, prescriptions, emergency services, lab tests, and more, often with $0 copays for covered services.
• Provider network: A statewide network of doctors and hospitals, so members can find care across MA or NH.
• Extra member perks: WellSense highlights added programs for Medicaid members. For example, members may earn rewards (like gift cards) for healthy activities, and they can get rides to medical appointments (as noted under “Rides to appointments” topics on the site). WellSense also prompts members to complete health surveys for a $30 reward.
• Care coordination: A team helps guide members to preventive care and chronic disease management. WellSense provides a 24/7 nurse advice line and has programs for special needs (e.g. for pregnancy, behavioral health, etc.) to keep members healthy.

Individual & Family Plans (Clarity Plans)

For those who buy private insurance (e.g. through the MA Health Connector), WellSense offers “Clarity Plans.” These have similar coverage to other ACA plans, with benefits like doctor visits, emergency care, prescription drugs, and the member extras listed above. Individual plans may offer some extras like vision or OTC supplies depending on level. (Specific Clarity plan details are on the WellSense site.) In short, whether via Medicare, Medicaid or Clarity plans, WellSense coverage includes comprehensive core benefits plus a variety of extras.

WellSense Health Plan Benefits in Detail

Below are some of the key benefits across WellSense plans:

• Low or $0 Premiums & Copays: Many plans feature $0 monthly premiums and minimal copays. For instance, primary care visits, generic drugs and preventive care can cost $0 for members.
• Prescription Drug Coverage: Plans cover a broad formulary. WellSense MA lists “coverage for thousands of prescription medications at over 1,000 retail and mail order pharmacies”. Both generic and brand drugs are covered, with some coinsurance or copays.
• Extensive Provider Network: WellSense boasts a large provider network. Members have thousands of doctors and specialists to choose from. HMO plans have broad in network choices and usually no referrals needed. If you can’t find a network provider, emergency and urgent care are always covered.
• Dental, Vision, Hearing: Many plans include routine dental cleanings (often 2x/year), glasses or contacts (yearly exam and eyewear), and hearing exams/aids. WellSense MA premium plans cover major dental work as well. Copays for these services are often $0.
• Over the Counter (OTC) Benefits: WellSense provides an OTC card loaded with funds each quarter. This lets members purchase approved health items at pharmacies or online. Eligible items include first aid supplies, vitamins, dental care products, incontinence supplies, and more. For example, WellSense Added Value plan members get $275 per quarter on the card. You can browse the full OTC catalog online to see eligible items.
• SilverSneakers Fitness: All WellSense MA plans include SilverSneakers®, giving free gym access and fitness classes. This supports healthy aging and wellness.
• Care Management & Support: Members with chronic illnesses can enroll in special care programs. A WellSense care manager will coordinate your care, help with medication management, and connect you to resources. The portal and plan offers tools like health assessments to see if you qualify.

In summary, WellSense’s core coverage mirrors standard Medicare and Medicaid benefits, while the extra benefits (fitness, OTC card, enhanced dental/vision, rewards, etc.) add tangible value. The official site notes that these extras and perks help members “every step of the way”.

Over the Counter (OTC) Card and Catalog

A standout benefit is the Over the Counter (OTC) allowance. Most WellSense plans (especially MA plans) include an InComm OTC card pre loaded with funds every quarter. This means members can shop for health items over the counter without cost.

• Funds & Schedule: Funds are deposited quarterly (Jan, Apr, Jul, Oct). For example, 2025 NH MA plans have up to $275 per quarter on one plan, $125 or $100 on others. Not all plans include OTC benefits (some less expensive plans do not).
• Eligible Items: The OTC allowance can be used on many everyday health supplies. Eligible items include first aid kits, bandages, wound care, dental care (toothbrushes, toothpaste, denture supplies), vitamins and supplements, incontinence products (adult diapers, pads), cold/cough medications, feminine care, skincare, and more. WellSense provides an online OTC catalog listing all covered items (accessible on their site).
• Where to Shop: Members can shop in person at most local drugstores and retailers, or online. The site explains you can shop at stores or use the OTC Network online portal or app. Participating retailers (over 1,000) are available for instance, retailers like Walgreens and Walmart participate.
• How to Use: Simply present your OTC Network card at checkout. If ordering online, you log into the network website or app and pay with the card. (Helpful video tutorials on the WellSense site show how to use the card.) Unused quarterly funds roll over until the next quarter (but may have an annual limit).
• OTC Catalog: The full catalog is available as a PDF on the WellSense site. It categorizes thousands of approved products by category (e.g. pain relief, baby care, nutrition). Whenever you have questions about coverage, you can check the online catalog or ask WellSense member services.

In short, the OTC benefit is like a flexible mini benefit to help cover everyday health purchases. It’s unique to Medicare Advantage plans and a valuable perk members effectively get free basic health supplies each quarter.

WellSense Health Plan ID Card

When you enroll in WellSense, you’ll receive a Member ID Card. This card shows your plan name, member ID number, group number, and doctor name. You should carry it to all medical appointments and pharmacy visits. Here’s what to know:

• Replacement Card: If you lose your card or need a new one, don’t worry. You can request a replacement through the member portal. Once logged in, select “Request ID Card” or similar WellSense will send you a new card in the mail. The site says “Lost your member ID card? Login or register for a member portal account to order a new member ID card.”.
• Updating Card Info: You can also change the primary care provider (PCP) listed on your card via the portal. Simply log in and update your PCP choice, and your card will reflect that change.
• Physical Card: Your physical card is used for all healthcare services. Always have it handy at doctor visits or pharmacies. If you see a provider not in your network, show your card it will have instructions on how to find in network doctors if needed.
• Digital Access: Even if you misplace the physical card, you can usually log into the member portal to view a digital copy of your card and key ID information 24/7.

In summary, the WellSense health plan card is your official insurance proof. Keep it safe, and use the portal to replace or update it as needed.

Finding Providers and Doctors

WellSense members can see doctors and specialists in network. To find a provider:

• Online Provider Search: The WellSense website has a “Find a Provider” tool. You can search for doctors by name, specialty or location. (Log in if needed, or use the public search.) The site’s provider directory covers all WellSense networks (Medicare, Medicaid, Clarity).
• Network Size: WellSense boasts a large network. For example, one MA page mentions “Large provider network”. In NH, their Delta Dental network has 875+ dentists, and the medical network includes all major hospital systems.
• No Referrals (for Most Plans): Most WellSense HMO plans do not require referrals to see specialists, though you generally must stay in network to avoid extra costs.
• Telehealth: WellSense offers telehealth visits 24/7 for non emergency issues. You can use telehealth for things like colds, flu, skin issues, or follow ups with your doctor. It’s a convenient option when you can’t see a doctor in person.
• New Providers: If your doctor is not available or not in network, you can switch providers. Contact Member Services or the portal to switch your PCP (primary care doctor).
• Second Opinions: You can get a second opinion from a qualified specialist if your PCP recommends it usually the plan covers this.

In practice, to make an appointment, simply give the provider your WellSense card. If it’s your first time with a provider, they may ask for ID and your WellSense ID number. Always verify the provider is in network to use your full benefits.

Applying for a WellSense Plan

If you’re interested in enrolling in a WellSense plan (Medicare, Medicaid, or individual), here’s how to apply:

1. Check Eligibility: Make sure you meet the eligibility criteria. For Medicare Advantage, you must be 65 or older and enrolled in Medicare Parts A & B. For Medicaid, you must meet income and other state requirements (MassHealth or NH Medicaid rules). For individual plans, you must live in the service area and apply during open enrollment or a special enrollment period.
2. Use Online Tools: WellSense provides an online shopping and enrollment tool. For example, in New Hampshire, the site says: “Use our online shopping tool to find WellSense Medicare Advantage plans near you, compare plan options side by side and enroll when you’re ready.”. Massachusetts has similar online enrollment. This tool lets you see available plans, benefits, and costs.
3. Contact WellSense: You can call WellSense member services or schedule an in person meeting with a representative. For Medicare, WellSense often holds events or counseling sessions. The site even suggests joining in person events or scheduling a call with a Medicare specialist if you need help.
4. Enroll Through Official Channels:
   • Medicare Advantage: Enroll during the Medicare Annual Election Period (Oct 15 to Dec 7) or during Fall Open Enrollment (Jan 1 to Mar 31 for those already in a Medicare Advantage). You can enroll directly on the WellSense site or through Medicare.gov.
   • Medicaid (MassHealth/NH Medicaid): Apply anytime through your state’s Medicaid office or website. WellSense will enroll you once approved by the state. Often this is handled automatically if you choose WellSense when assigned a managed care plan.
   • Individual (Clarity) Plans: Enroll via the Massachusetts Health Connector (MA) or your state’s exchange. Open enrollment is typically Nov 1 to Jan 23 each year, with Special Enrollment Periods as available.
5. Apply via Phone or Mail: If online is not an option, you can call WellSense (TTY:711) or your state’s insurance hotline for assistance. They can help you fill out forms or even sign you up over the phone.

Once enrolled, you’ll receive a welcome packet with your Member ID card, plan information, and instructions on how to log in to the member portal. Keep in mind that some plans have effective date rules (for example, Medicare plans usually take effect Jan 1 if enrolled by Dec 7).

In summary, you can apply for a WellSense plan online or by calling member services. The key is to compare plan options, check benefits, and enroll during the proper enrollment window. WellSense’s online “Shop Our Plans” tool and customer service line can guide you through the process.

Member Portal & Customer Support WellSense Health Plan

WellSense offers a secure online member portal where you can manage your plan at any time. The portal is accessible via the “Login” link on wellsense.org (it uses the HealthTrioConnect system). Here’s what members can do:

• Access Your Account 24/7: You can view your plan details, benefits, claims, and claims status 24/7 through the portal. The site notes: “With a member portal account, you can easily access your plan information — whenever it’s convenient for you, 24/7.”.
• Manage Personal Information: Through the portal you can update your address, phone number and other contact info. If you move or change your PCP, just log in to make changes and keep your plan records current.
• View Documents: Important documents like Evidence of Coverage (EOC), Summary of Benefits, and Explanation of Benefits (EOB) statements can be downloaded from the portal. This lets you track your medical expenses and coverage.
• Prescription Refills: Many portals allow you to view your prescription drug list and even refill maintenance meds online. (Check if WellSense’s site offers this via the portal or a linked pharmacy portal.)
• Order ID Card: If you need a new member ID card, you can request one online. Under the “Request an ID Card” section, simply click to have a replacement mailed out.
• OTC and Extra Benefits: Some portals also let you check your OTC card balance and catalog, or book extra services (like scheduling a call with a care manager or signing up for a fitness program).
• Contact Member Service: There’s often a messaging or support feature to ask questions securely.

Logging In: To use the portal, go to the WellSense website and click “Member Login”. First time users must register by providing name, DOB, member ID, etc. Once registered, set a username and password. If you ever forget login info, you can reset it online or call support for help.

Customer Service: WellSense has dedicated representatives to answer questions:

• Phone: You can call 866-773-2056 (TTY: 711) for member services. The lines are typically open 8am to 8pm (M-F or 7 days/week depending on state). This number can help with any question from finding doctors to clarifying benefits.
• In Person Help: During open enrollment periods, WellSense may offer in person events or enrollments. Check the website for local seminars or clinics.
• Mail: For general inquiries, the contact page provides a mailing address. You can also fax documents if needed.
• Health Equity & Language Services: WellSense offers assistance in multiple languages (note the site’s language list). If you need interpreters or translated materials, customer service can arrange these.

By using the portal and phone support, members have multiple ways to get answers. The portal is especially convenient for quick tasks (e.g. “Get my benefits” or “Order a card”) while the call center is good for complex issues.

Frequently Asked Questions

Q: How do I log in to my WellSense Health Plan account?
A: To log in, go to the WellSense website and click “Member Login.” First time users must register by entering their name, date of birth and member ID (found on your ID card). Once registered, set a username/password. Afterward, use those credentials to log in anytime. This portal gives 24/7 access to your plan info, claims, and benefits. If you forget your password, use the “Forgot Password” link or contact Member Services for help.

Q: What benefits does my WellSense health plan cover?
A: WellSense plans cover standard medical, hospital, and prescription benefits. Most plans include extra benefits like dental, vision, hearing and fitness programs. For Medicare Advantage members, the plan combines Part A/B/D into one package and adds perks (e.g. $0 preventive dental, SilverSneakers, OTC card). Medicaid plans cover all Medicaid services plus extras (like care coordination and rewards). Always check your Evidence of Coverage for a full list of covered services.

Q: How do I use the WellSense OTC (over the counter) benefit?
A: WellSense provides an OTC Network card preloaded with funds each quarter. Eligible items include first aid supplies, vitamins, dental care products, incontinence supplies, and more. To use it, shop at participating retailers (like pharmacies or Walmart) and pay with your OTC card. You can also shop online via the OTC Network website or app. A complete OTC catalog of approved items is available on the WellSense site. Unused funds roll over each quarter up to your plan’s limit.

Q: How do I find a WellSense approved doctor or provider?
A: Use the WellSense “Find a Provider” tool on the website. You can search by specialty, name or location. The network is large (e.g. 875+ dentists in NH). If you’re enrolled in an HMO, choose in network doctors to avoid extra costs (most visits have $0 copay). PPO plans also have networks but allow limited out of network coverage. You can switch your primary care doctor by logging into the portal or calling Member Services if needed.

Q: How can I apply for a WellSense plan?
A: For Medicare Advantage, enroll during Medicare’s open enrollment (Oct to Dec 7) or fall open enrollment (Jan-Mar). Go to wellsense.org and use the plan finder to enroll, or call WellSense. For Medicaid, apply through MassHealth/NH Medicaid at any time once approved, select WellSense as your managed care plan. For individual (Clarity) plans, apply through the state health exchange during open enrollment. The WellSense online tool and customer service team can guide you through eligibility and enrollment.

Q: Does WellSense have a member services phone number?
A: Yes. Call 866-773-2056 (TTY: 711) to reach WellSense Member Services. Representatives can answer coverage questions, help find providers, assist with claims issues, or enroll you in programs. Customer service is available weekdays (and often weekends) during set hours. If you need language assistance, interpreters are available upon request.

Q: Do people review or rate WellSense plans?
A: WellSense may not have public plan ratings like some commercial insurers, but you can find general feedback online. Employee reviews on sites like Indeed or Glassdoor note that “WS truly cares about its members”, indicating a member focused culture. For official plan performance (quality ratings, member satisfaction surveys), check Medicare’s star ratings or your state Medicaid quality reports. Always compare plans based on the specific benefits and coverage you need.

Conclusion

The WellSense Health Plan login portal is your gateway to managing these benefits and more. Whether you’re reviewing your coverage, ordering an ID card, or checking OTC balances, logging in puts the tools at your fingertips. In summary, WellSense offers comprehensive coverage (hospital, doctor, RX) plus valuable extras (OTC supplies, dental, vision, fitness, etc.). Members in MA and NH appreciate the strong provider networks, preventive services, and member centric support.

Remember, you can apply for WellSense coverage via the official site or your state’s enrollment system, and contact customer service at 866-773-2056 for personal assistance. We hope this guide helps you understand your WellSense plan’s coverage and benefits. If you found this information useful, please consider sharing it with others or commenting below. Stay connected on social media for more health coverage tips, and let us know if you have any questions about WellSense Health Plan!

Sources: Official WellSense Health Plan website pages on Medicare Advantage benefits, Medicaid member information, member portal and OTC card details, and plan finder tools.

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