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Do you want to disenroll from your Wellcare plan? We're sorry to see you go!

You can use the Disenrollment Form to disenroll from your Wellcare plan. Note that if you request disenrollment, you must continue to get all medical care from your plan until the effective date of disenrollment. Contact Us to verify your disenrollment before you seek medical services outside of our network. We will notify you of the effective date of your disenrollment from the plan following receipt of this form.


You may type to complete the Medicare Disenrollment Form (PDF), or PDP Disenrollment Form (PDF). To do so, download and complete the form on your computer using a program like Adobe Acrobat Reader. Your form must have a completed signature in order to be considered complete. You can download a free version of Adobe Reader at

Please mail or fax your completed form. 

For more information on disenrollment, including your rights and responsibilities upon disenrollment, refer to the following chapters in your Evidence of Coverage:

  • Medicare Members: Chapter 8 on Member Rights and Responsibilities and Chapter 10 on Disenrollment
  • Prescription Drug Plan Members: Chapter 6 on Member Rights and Responsibilities and Chapter 8 on Disenrollment 
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On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.