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Wellcare Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in Washington. The overall rating for this plan is not yet available for 2025.
It's important to know that Wellcare Simple (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 Simple (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 Simple (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $420.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 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 Simple (HMO-POS) plan has a $420 deductible for prescription drugs. During the initial coverage phase, after you pay the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and standard mail pharmacies, and a $10 copay at standard pharmacies. For standard generic drugs, you pay 25% coinsurance regardless of the pharmacy. Preferred brand drugs have 36% coinsurance, while non-preferred drugs have 28% coinsurance. Specialty tier drugs have no copay. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, and pay nothing for your Part D covered drugs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a wide array of benefits with varying costs. Inpatient hospital stays have a $400 copay for days 1-5, and no copay for days 6-90. Outpatient services, primary care, preventive services, vision, dental, and home health services often have no copay or a small copay, while other services like ambulance, emergency, and partial hospitalization services have higher copays. This plan covers a range of services, from hearing and vision to dental and medical equipment. Hearing aids are covered up to $1,000 per year, and prescription eyewear is covered with no copay up to $200 per year. Diagnostic, radiological, and skilled nursing facility services have varying copays or coinsurance, and other services like acupuncture and OTC items are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For days 1-5, you will pay a $400 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $350, observation services with a copay between $125 and $350, ambulatory surgical center services with a $225 copay, and outpatient substance abuse services with a $30 copay for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple (HMO-POS) plan, but requires prior authorization. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple (HMO-POS) plan. Ground and Air Ambulance Services have a copay of $310, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare Simple (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay, and all have no coinsurance. Worldwide Urgent Coverage has a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $15 copay, physician specialist services with a $15 copay, and mental health specialty services with a $30 copay for individual and group sessions. The plan also covers podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a $15 copay.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visits, all with no copay. Kidney disease education services have a 20% coinsurance. Other services like health education, in-home safety assessments, and several others are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $1,000 per year, and no copay for all types of prescription hearing aids except inner ear, outer ear, and over the ear. OTC hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) covers vision services, including eye exams with a copay of $0-$15 and routine eye exams with no copay. Eyewear is covered with no copay, and a combined maximum benefit of $200 per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay.
Dental Services See details
Wellcare Simple (HMO-POS) covers dental services, including oral exams with no copay, and Medicare dental services with a $15 copay. Other services like Dental X-Rays, and other preventive dental services have no copay, while Orthodontic services have a maximum plan benefit of $1500.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Simple (HMO-POS) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Wellcare Simple (HMO-POS) plan covers medical equipment, including Durable Medical Equipment (DME), with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with the plan requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $310, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Simple (HMO-POS) plan, but the specific services listed are not covered. The plan has a copay for some cardiac and pulmonary rehabilitation services, but specific copay amounts are not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture and over-the-counter (OTC) items. Acupuncture has no copay and requires prior authorization, and is limited to 24 treatments per year. OTC items also have no copay, with a maximum benefit coverage amount of $110 every three months.
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