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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 2026, 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 2026.
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 $615.00 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 $6500.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 select care drugs are highly affordable, requiring no copay across all standard and preferred pharmacy and mail-order options. If you fill Tier 1 or Tier 2 prescriptions at a standard pharmacy, copays range from $5 to $30 depending on the tier and supply. For higher-tier medications, Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs require 35% to 36% coinsurance depending on your pharmacy choice. This structure offers significant savings opportunities if you utilize preferred network pharmacies for your prescriptions.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits and a low $15 copay for specialist consultations. For inpatient hospital stays, members pay a daily copay of either $400 or $450 for the first five days, followed by no copay for days six through ninety. Outpatient hospital services require copays ranging from no copay up to $450, while emergency room visits carry a $130 copay that is waived if you are admitted. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copay, no deductibles, and no coinsurance. Members receive up to $1,500 annually for dental care, a $200 yearly limit for eyewear, and up to $1,000 per ear annually for prescription hearing aids. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance, while home health services and over-the-counter items are available with no copay.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) offers partially covered inpatient hospital services, as acute upgrades, additional days, and non-Medicare-covered stays are not covered. Acute stays require a $450 copay for days 1 to 5, no copay for days 6 to 90, and no coinsurance, while psychiatric stays require a $400 copay for days 1 to 5, no copay for days 6 to 90, and no coinsurance.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $130 to $450 copay per stay for observation services. Ambulatory surgical center services require a $225 copay, outpatient substance abuse sessions have a $30 copay, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple (HMO-POS) with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $310 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Wellcare Simple (HMO-POS) with a $130 copay and no coinsurance, while urgently needed services require a $50 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum benefit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) primary care benefits feature no copay and no coinsurance for primary care physician services, while specialist visits, physical therapy, and routine podiatry require a $15 copay and no coinsurance. Chiropractic services are partially covered, offering routine care for a $15 copay and no coinsurance while other chiropractic services are not covered. Mental health, psychiatric, and telehealth services are also covered with no coinsurance and copays ranging from $0 to $50.
Preventive Services See details
Wellcare Simple (HMO-POS) covers preventive services, including annual physical exams, fitness benefits, alternative therapies, and remote access technologies with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Additional preventive benefits are only partially covered, as the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home and bathroom safety devices, or counseling services.
Hearing Services See details
Hearing services are partially covered by Wellcare Simple (HMO-POS), featuring a $15 copay and no coinsurance for Medicare-covered exams, and no copay, no coinsurance, and no deductible for annual routine exams and fittings. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, but OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) provides partially covered vision services with no coinsurance, no deductibles, and prior authorization required, though other eye exam services are not covered. Routine eye exams are covered with no copay (with a copay of $0.00 to $15.00 for other exams), and eyewear is covered with no copay up to a $200 yearly limit.
Dental Services See details
Wellcare Simple (HMO-POS) dental services are partially covered, featuring a $15 copay and no coinsurance for Medicare-covered dental care. Preventive and comprehensive dental services are offered with no copay and no coinsurance up to a $1,500 yearly maximum, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay, while Medicare Part B insulin drugs require a $35 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation, have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $30 copay for procedures, while radiological services require a $50 copay for outpatient X-rays, a minimum 20% coinsurance for therapeutic radiology, and no copay for diagnostic radiology.
Home Health Services See details
Home health services are covered under the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) covers some cardiac rehabilitation services with no coinsurance and no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 51 through 100, while days 21 through 50 require a $218 daily copay, with additional days beyond the 100-day limit not covered.
Other Services See details
Wellcare Simple (HMO-POS) provides coverage for acupuncture (up to 24 treatments per year with prior authorization required) and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits and other additional services are not covered under this plan.
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