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Wellcare Giveback (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback (HMO) 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) is a HMO plan offered by Wellcare of Texas, Inc. available for the 2026 plan year to people living in Select Counties in Texas. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Wellcare Giveback (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 Giveback (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 Giveback (HMO), 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 $59.00. 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 $7500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7500.00 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) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 select care drugs are available with no copay across all standard and preferred pharmacies and mail-order options. For brand-name and specialty medications, the plan charges a 25% coinsurance for Tier 3 preferred brands and Tier 5 specialty drugs, while Tier 4 non-preferred drugs require a 50% coinsurance. If you choose to fill Tier 1 or Tier 2 prescriptions at a standard pharmacy, copays range from $5 to $30 depending on the tier and supply. This structure helps beneficiaries minimize out-of-pocket prescription costs by utilizing preferred network services.
Additional Benefits
The Wellcare Giveback (HMO) plan offers comprehensive medical coverage featuring no copays for primary care visits, annual physicals, and home health services. For specialist visits, members pay a $50 copay, while inpatient hospital stays require a $400 copay for days 1 through 6 with no copay for days 7 through 95. Outpatient hospital services and emergency care are also covered with no coinsurance, requiring copays up to $425 and $115 respectively. Routine dental cleanings, annual eye exams, and routine hearing tests are covered with no copay or coinsurance. Additionally, the plan provides helpful allowances for eyewear up to $300 annually and hearing aids up to $350 per ear with no copays. Durable medical equipment and dialysis services are also covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Giveback (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $400 copay for days 1-6 of acute stays (no copay for days 7-95) and a $300 copay for days 1-6 of psychiatric stays (no copay for days 7-90). Prior authorization is required for these services, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Giveback (HMO) covers outpatient hospital services with no coinsurance and copays ranging from no copay to $425, alongside observation services with a $115 to $425 copay and no coinsurance. Additionally, ambulatory surgical center services require a $250 copay and no coinsurance, while outpatient substance abuse services carry a $25 copay and no coinsurance, and outpatient blood services have no copay, coinsurance, or deductible.
Partial Hospitalization See details
Wellcare Giveback (HMO) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Giveback (HMO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and cost-sharing that counts toward the plan-level deductible. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum benefit with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Physical, occupational, and speech therapy services are covered with a $35 copay and no coinsurance, but podiatry is not covered, and chiropractic services are only partially covered with routine and other chiropractic services excluded from coverage.
Preventive Services See details
Wellcare Giveback (HMO) covers preventive services with no copay and no coinsurance for annual physicals, memory fitness, alternative therapies, remote access, and select screenings, while kidney disease education is covered with no copay and a 20% coinsurance. This benefit is only partially covered, as it excludes health education, in-home safety assessments, PERS, 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, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing Services through Wellcare Giveback (HMO) cover routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $50 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $350 per ear annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Giveback (HMO) vision services are partially covered, featuring no coinsurance and no copays for annual routine eye exams and eyewear, including contacts and eyeglasses, up to a $300 yearly limit. Other eye exam services are not covered under this plan, and prior authorization is required for exams and eyewear.
Dental Services See details
Wellcare Giveback (HMO) partially covers dental services, offering Medicare-covered dental with a $50 copay and no coinsurance, and preventive services like cleanings and exams with no copay or coinsurance. Prior authorization is required for most services, and non-covered benefits include restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Giveback (HMO) with no copay, though prior authorization and step therapy may be required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellcare Giveback (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Giveback (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, with prior authorization required. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Wellcare Giveback (HMO) covers diagnostic and radiological services, with prior authorization required for these benefits. Diagnostic services feature no coinsurance, offering lab tests with no copay and diagnostic procedures with a copay ranging from $0 to $50. Radiological services include diagnostic imaging with copays starting at $0, outpatient X-rays with a $50 copay, and therapeutic services with a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellcare Giveback (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Giveback (HMO) plan.
Skilled Nursing Facility (SNF) See details
Wellcare Giveback (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization and no prior three-day hospital stay. You will pay no copay for days 1 to 20 and days 61 to 100, a $218 daily copay for days 21 to 60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Wellcare Giveback (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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