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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 2025, 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 3.5 out of 5 stars in 2025.
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 $17.90. 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 $590.00 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) plan has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, for preferred generic drugs, you will pay a $19.00 copay at a preferred pharmacy, and for specialty tier drugs, you will have no copay at a preferred pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Assist (HMO) plan offers comprehensive coverage with a focus on affordability and preventive care. This plan features no copays for primary care visits, preventive services like annual physicals, and many outpatient services. You'll have copays for services like inpatient hospital stays, specialist visits, and emergency care, with varying costs depending on the service. The plan also includes benefits for hearing, vision, and dental services, with coverage for exams, eyewear, and dental procedures. Additionally, the plan covers ambulance and transportation, home health, and offers an over-the-counter (OTC) allowance. However, certain services like cardiac rehabilitation and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $275 copay for days 1-5, and no copay for days 6-90; additional days for Inpatient Hospital-Acute have no copay for days 91-120. For Inpatient Hospital Psychiatric, there is a $225 copay for days 1-5, and no copay for days 6-90. However, the plan does not cover Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $0 to $280, observation services with a copay of $140 to $280, ambulatory surgical center services with a $150 copay, and outpatient substance abuse services with a $25 copay for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist (HMO) plan, but requires prior authorization. You will have a $130 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Assist (HMO) plan. Ground and Air Ambulance Services each have a $250 copay, while Transportation Services to a Plan Approved Health-related Location has no copay, with a limit of 24 one-way trips per year. Transportation Services to any other health-related location are not covered.
Emergency Services See details
Emergency Services under the Wellcare Assist (HMO) plan include a $140 copay, with no coinsurance. Urgently Needed Services have a $25 copay, with no coinsurance. Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered with a $140 copay, with no coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $20 copay, and specialist visits with a $20 copay. Mental health services, including individual and group sessions, have a $25 copay, while physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits have a copay between $0 and $25, and opioid treatment program services have a $20 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Wellcare Assist (HMO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services are covered with 20% coinsurance.
Hearing Services See details
The Wellcare Assist (HMO) plan covers hearing exams with a $20 copay and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $1,000 per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay between $0 and $20, and eyewear with no copay. Routine eye exams are covered with no copay, and you are allowed one exam per year. Eyewear has a combined maximum benefit of $200 per year for all eyewear, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services, including Medicare Dental Services, are covered with a $20 copay. Other services such as oral exams, dental x-rays, and other diagnostic dental services have no copay, while orthodontics has a maximum plan benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Assist (HMO) plan, and require prior authorization. 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 Assist (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics, Medical Supplies, and Diabetic Equipment, are covered under the Wellcare Assist (HMO) plan. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $50, lab services with no copay, and outpatient X-ray services with a $50 copay. Therapeutic Radiological Services have a coinsurance of at least 20%, and Diagnostic Radiological Services have a copay of at most $200.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist (HMO) 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 not covered by the Wellcare Assist (HMO) plan. Although the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Wellcare Assist (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and a Meal Benefit. OTC items have no copay, and the plan offers up to $75 every three months for OTC items. The Meal Benefit also has no copay and requires a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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