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Wellcare Giveback (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback (HMO-POS) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Giveback (HMO-POS) is a HMO-POS plan offered by Coordinated Care of Washington, Inc. available for the 2026 plan year to people living in Select Counties in Washington. CMS star rating not available for 2026.
It's important to know that Wellcare Giveback (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Giveback (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellcare Giveback (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $62.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Wellcare Giveback (HMO-POS) prescription drug plan features an annual drug deductible of $615. Beneficiaries can enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when filling prescriptions through preferred pharmacies or preferred mail order. Additionally, Tier 6 select care drugs require no copay across all standard, preferred, and mail order pharmacy options. For higher-tier medications, the plan utilizes coinsurance, charging 25% coinsurance for both Tier 3 preferred brand drugs and Tier 5 specialty drugs. Tier 4 non-preferred drugs carry a 44% coinsurance across all pharmacy types and delivery methods. If you choose to use standard pharmacies or standard mail order for Tier 1 and Tier 2 generics, you will pay copays ranging from $5 to $30 depending on the prescription supply length.
Additional Benefits
The Wellcare Giveback (HMO-POS) plan offers essential medical coverage with no deductibles and no coinsurance for many primary services. Beneficiaries enjoy no copay for primary care provider visits, select telehealth services, and home health care, while specialist visits require a $30 copay. For acute inpatient hospital stays, there is a $475 copay for days 1 through 5 and no copay for days 6 through 90, while emergency room visits carry a $115 copay. Many additional benefits, including preventive care, routine dental, and routine vision and hearing exams, are covered with no copay and no coinsurance. Comprehensive dental services are covered with no copay and a 20% coinsurance up to a $1,000 annual limit, while routine eyewear and prescription hearing aids are covered with no copay up to annual allowance limits. Durable medical equipment, diabetic shoes, and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Giveback (HMO-POS) with no coinsurance, as upgrades, non-Medicare-covered stays, and additional days are not covered. For covered acute stays, there is a $475 copay for days 1 through 5 and no copay for days 6 through 90, while psychiatric stays require a $400 copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Outpatient Services are covered under the Wellcare Giveback (HMO-POS) plan with no coinsurance, featuring outpatient hospital copays ranging from $0 to $500 and observation copays from $115 to $500. Ambulatory surgical center services require a $275 copay with no coinsurance, and outpatient substance abuse sessions have a $40 copay with no coinsurance. Outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare Giveback (HMO-POS) covers partial hospitalization benefits with a $105.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Giveback (HMO-POS), with ground and air ambulance trips requiring a $300 copay and no coinsurance. However, transportation services are not covered in practice, as trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Wellcare Giveback (HMO-POS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback (HMO-POS) covers primary care physician services and select telehealth benefits with no copay and no coinsurance, while specialist and therapy visits require a $30 copay and no coinsurance. Chiropractic benefits are partially covered, offering routine care with a $15 copay and no coinsurance for up to 12 visits per year, while other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Wellcare Giveback (HMO-POS), featuring no copay and no coinsurance for annual physicals, fitness programs, alternative therapies, remote access, and screenings, while kidney disease education has no copay and a 20% coinsurance. However, sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Wellcare Giveback (HMO-POS) covers Medicare-covered hearing exams for a $30 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Wellcare Giveback (HMO-POS) partially covers vision services with no deductibles, excluding other eye exam services which are not covered. Covered routine eye exams and eyewear (including lenses and frames) have no copay and no coinsurance, subject to a $100 annual eyewear limit, while other covered eye exams require a $0 to $30 copay and no coinsurance.
Dental Services See details
Dental services are partially covered by Wellcare Giveback (HMO-POS), offering preventive care with no copay and no coinsurance, and Medicare-covered dental for a $30 copay and no coinsurance. Covered comprehensive services require no copay and a 20% coinsurance up to a $1,000 annual limit, but fixed and removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Giveback (HMO-POS) with no copay, though prior authorization and step therapy may be required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellcare Giveback (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Giveback (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no copay from specified manufacturers, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Giveback (HMO-POS), with prior authorization required for all services. Diagnostic services feature no coinsurance, with no copay for lab services and no copay to a $30 copay for diagnostic tests, while radiological services range from no copay for diagnostic radiology to a $50 copay for X-rays and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the Wellcare Giveback (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Giveback (HMO-POS) offers cardiac rehabilitation services with no coinsurance, though only some services are covered. Specifically, standard cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $40 copay), pulmonary rehabilitation (with a $25 copay), and supervised exercise therapy for peripheral artery disease (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Giveback (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 to 20 and days 71 to 100, a $218 daily copay for days 21 to 70, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Giveback (HMO-POS) provides partial coverage for other services, offering acupuncture with no copay and no coinsurance for up to 12 treatments per year, subject to prior authorization. Over-the-counter (OTC) items, meal benefits, and other supplemental services are not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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