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Wellcare Assist (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO) in 2026, please refer to our full plan details page.
Wellcare Assist (HMO) is a HMO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in TX. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Wellcare Assist (HMO) 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 Assist (HMO).
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 Assist (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $3450.00 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 Assist (HMO) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply at a preferred pharmacy. Notably, you can save with no copay for a three-month supply of these generic drugs when using preferred mail-order services. Tier 3 preferred brand drugs require a 20% to 21% coinsurance, while Tier 4 non-preferred drugs have a copay starting at $100 per month. Specialty medications in Tier 5 carry a 25% coinsurance for a one-month supply, whereas Tier 6 select care drugs are highly accessible with no copay across all pharmacies and mail-order options.
Additional Benefits
Wellcare Assist (HMO) offers comprehensive healthcare coverage with no copay and no coinsurance for primary care visits, physical therapy, and routine preventive services. For inpatient hospital stays, members pay a $225 daily copay for days one through five and no copay for days six through 90, with no coinsurance required. Specialist visits require a $20 copay, while emergency services are covered with a $150 copay and no coinsurance. The plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care with no copay up to a $3,000 annual maximum, alongside routine vision and hearing services with no copay. While home health care and over-the-counter items have no copay, specialized services like dialysis, therapeutic radiology, and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Wellcare Assist (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization and a $225 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Acute stays include up to 30 additional days with no copay, but room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Assist (HMO) outpatient services are covered with no coinsurance, though prior authorization is required for some services. Copays range from no copay up to $250 for outpatient hospital services, $150 for ambulatory surgical center visits, $25 for outpatient substance abuse sessions, and no copay for blood services.
Partial Hospitalization See details
Wellcare Assist (HMO) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Assist (HMO), which offers Medicare-covered ground and air ambulance services for a $250 copay and no coinsurance, subject to prior authorization. However, transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Assist (HMO) covers emergency services with a $150 copay and urgently needed services with a $25 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 lifetime maximum with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO) covers primary care, occupational therapy, and physical therapy with no copay and no coinsurance, while specialist and mental health services require copays of $20 and $25 respectively with no coinsurance. Telehealth benefits range from no copay to a $25 copay with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Assist (HMO) covers preventive services, including annual physical exams, fitness benefits, alternative therapies, and remote access technologies with no copay and no coinsurance. Kidney disease education is covered with no copay and 20% coinsurance, while other services like glaucoma screenings and diabetes training require no copay and no coinsurance. Several supplemental preventive services, such as health education, in-home safety assessments, and nutritional benefits, are not covered.
Hearing Services See details
Wellcare Assist (HMO) covers Medicare-covered hearing exams for a $20 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $500 annual maximum per ear, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Wellcare Assist (HMO) partially covers vision services, offering eye exams with a $0 to $20 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear—including contacts, eyeglasses, lenses, frames, and upgrades—features no copay, no coinsurance, and no deductible up to a combined maximum benefit of $200 annually.
Dental Services See details
Wellcare Assist (HMO) partially covers dental services, offering Medicare-covered dental with a $20 copay and no coinsurance, and preventive and comprehensive services with no copay and no coinsurance up to a $3,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered by this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Assist (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Assist (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under Wellcare Assist (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay, subject to specified manufacturer limitations, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Assist (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and diagnostic radiology with no copay or coinsurance. Diagnostic tests and procedures have no coinsurance and a copay ranging from $0 to $50, while outpatient X-rays require a $50 copay and therapeutic radiology has a 20% coinsurance.
Home Health Services See details
Home health services are covered under the Wellcare Assist (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Assist (HMO) with no coinsurance, though copays vary by the specific service. You will pay a $50 copay for standard cardiac rehabilitation, $65 for intensive cardiac rehabilitation, $40 for pulmonary rehabilitation, and $30 for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Wellcare Assist (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond standard Medicare coverage are not covered. There is no copay for days 1 through 20 and days 41 through 100, while days 21 through 40 require a $218 daily copay.
Other Services See details
Wellcare Assist (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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