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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 2025, please refer to our full plan details page.
Wellcare Giveback (HMO) is a HMO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in Texas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $102.60. You must continue to pay paying your reduced 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 $6900.00 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 Giveback (HMO) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For the initial coverage phase, you will pay no copay for preferred generic and specialty tier drugs at preferred pharmacies. Standard generic drugs have a 25% coinsurance, while preferred brand drugs have a 44% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Giveback (HMO) plan offers a range of benefits with varying costs. You'll find no copay for primary care visits, annual physical exams, and home health services, along with no copay for many preventive and vision services. Copays apply to other services like inpatient hospital stays, outpatient services, specialist visits, and emergency care, with costs depending on the specific service. The plan includes coverage for hearing and dental services, with copays for exams and some treatments, and offers coverage for medical equipment with coinsurance. Diagnostic and radiological services have a mix of copays and coinsurance. While some services like skilled nursing and home infusion require prior authorization, other services such as acupuncture, over-the-counter items, and meal benefits are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Wellcare Giveback (HMO) plan. For Inpatient Hospital-Acute, you will pay a copay of $435 for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a copay of $370 for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered by the Wellcare Giveback (HMO) plan, including outpatient hospital services with a copay between $0 and $350, observation services with a copay between $110 and $350, ambulatory surgical center (ASC) services with a $250 copay, and outpatient substance abuse services with a $25 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Giveback (HMO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Giveback (HMO) plan. Ground and air ambulance services have a $250 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency coverage, are covered under the Wellcare Giveback (HMO) plan. Emergency services have a $110 copay, and urgently needed services have a $45 copay, both with no coinsurance. Worldwide urgent coverage has a $110 copay and worldwide emergency transportation is not covered.
Primary Care See details
The Wellcare Giveback (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services with a $50 copay, mental health specialty services with a $25 copay for individual or group sessions, and physical therapy and speech-language pathology services with a $35 copay. Additional telehealth benefits have a copay ranging from $0 to $50, and opioid treatment program services have a $50 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services with a copay. The plan also covers Kidney Disease Education Services with 20% coinsurance. Other preventive services include no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit.
Hearing Services See details
Hearing exams have a $50 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams, with a copay of $0-$50, and eyewear, which has a combined maximum benefit of $100 per year with no copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay.
Dental Services See details
The Wellcare Giveback (HMO) plan covers Medicare Dental Services with a $50 copay, and also covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare Giveback (HMO) plan, with a $35 copay for Medicare Part B Insulin Drugs and coinsurance for other services. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Giveback (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Giveback (HMO) plan, with a 20% coinsurance for Durable Medical Equipment (DME) and Prosthetic Devices, and a 20% coinsurance for Medical Supplies. 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 all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests have a copay between $0 and $30, lab services have no copay, diagnostic radiological services have a copay up to $300, therapeutic radiological services have 20% coinsurance, and outpatient X-ray services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Giveback (HMO) plan, but the plan does not cover any of the listed sub-services. The plan does not provide any copay or coinsurance information for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Giveback (HMO) plan, with prior authorization required. For days 1-20 and 71-100, there is no copay, but for days 21-70, the copay is $214.
Other Services See details
Other Services, including acupuncture, over-the-counter items, meal benefits, and more, are not covered by the Wellcare Giveback (HMO) plan. No authorization or referrals are required for these services.
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