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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 $95.00. 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 $7900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7900.00 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 drug deductible of $615. You can maximize your savings by using preferred pharmacies or preferred mail-order services, which offer no copay for Tier 1 preferred generic and Tier 2 generic drugs. Additionally, Tier 6 select care drugs feature no copay across all pharmacies, while standard pharmacies charge copays starting at $5 for Tier 1 and $10 for Tier 2 medications. For higher-tier medications, your costs will be based on coinsurance rather than flat copays. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance. These coinsurance percentages remain consistent across preferred and standard pharmacies as well as mail-order options.
Additional Benefits
The Wellcare Giveback (HMO) plan offers affordable access to essential medical care, featuring no copay and no coinsurance for primary care visits, preventive screenings, and home health services. Specialist visits require a $50 copay, while inpatient hospital stays incur a $475 copay per day for the first five days of acute care. Emergency room visits carry a $115 copay, and outpatient hospital services range from no copay up to a $450 copay. While routine hearing exams and preventive dental care are available with no copay, vision services and restorative dental treatments are not covered by this plan. For durable medical equipment and dialysis services, members pay no copay but are responsible for a 20% coinsurance. Diagnostic laboratory and diagnostic radiological services are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits under Wellcare Giveback (HMO) are partially covered with no coinsurance, requiring a $475 copay for days 1-5 of acute stays (no copay for days 6-95) and a $370 copay for days 1-5 of psychiatric stays (no copay for days 6-90). Prior authorization is required for these services, while 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 $450, and ambulatory surgical center services with a $300 copay and no coinsurance. Outpatient substance abuse services require a $25 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Giveback (HMO) with a $105.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO) partially covers ambulance and transportation services, providing Medicare-covered ground and air ambulance services for a $300 copayment per service and no coinsurance, subject to prior authorization. Transportation services to plan-approved health-related locations and any health-related locations are not covered.
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 copays waived if admitted within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback (HMO) offers primary care provider visits with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Physical, occupational, and speech therapy services have a $35 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by the Wellcare Giveback (HMO), offering annual physical exams, alternative therapies, and select screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Supplemental services such as health education, weight management, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Wellcare Giveback (HMO) hearing services are partially covered, offering Medicare-covered exams for a $50 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $350 per ear annually with no copay or coinsurance, though inner ear, outer ear, over-the-ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are not covered under the Wellcare Giveback (HMO) Medicare Advantage plan, meaning there is no copay, coinsurance, or deductible because routine eye exams, other eye exams, contact lenses, and eyeglasses are all excluded from coverage.
Dental Services See details
Wellcare Giveback (HMO) covers Medicare-covered dental services for a $50 copay and no coinsurance, and offers preventive dental services with no copay and no coinsurance. Dental benefits are partially covered, as restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Giveback (HMO) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Wellcare Giveback (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Giveback (HMO) with no copay and a 20% coinsurance for durable medical equipment (DME), prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Giveback (HMO) with prior authorization required, featuring no copay or coinsurance for lab services and diagnostic radiological services. Diagnostic procedures and tests require a $0 to $30 copay with no coinsurance, while outpatient X-rays have a $50 copay with coinsurance, and therapeutic radiological services incur a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Wellcare Giveback (HMO) plan feature no coinsurance, but in practice only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Giveback (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1-20 and 61-100, a $218 copay per day for days 21-60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Giveback (HMO) states that some services are covered under its other services benefit, but in practice, acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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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