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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.
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 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 $109.00. 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 $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 $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) prescription drug plan features an annual drug deductible of $615. You can enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled at a preferred pharmacy or through preferred mail order. Additionally, Tier 6 select care drugs are highly accessible with no copay at any preferred or standard pharmacy. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs require a 46% coinsurance. Standard pharmacies and standard mail order options charge copays ranging from $5 to $30 for Tier 1 and Tier 2 drugs.
Additional Benefits
The Wellcare Giveback (HMO) plan offers robust coverage for essential medical care, featuring no copays and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits, patients can expect a $50 copay, while inpatient hospital stays require daily copays for the first five days before transitioning to no copay for longer stays. Emergency services are covered with a $115 copay, and urgent care visits carry a $30 copay, with no coinsurance required for either service. This plan also provides valuable supplemental benefits, including routine dental, vision, and hearing exams with no copays or coinsurance, alongside a $100 annual eyewear allowance and up to $350 per ear annually for prescription hearing aids. Diagnostic lab tests and diabetic supplies are also covered with no copay, though durable medical equipment and dialysis services require a 20% coinsurance. Please note that several standard supplemental benefits, such as over-the-counter items, meal programs, and transportation services, are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital services are covered by Wellcare Giveback (HMO) with no coinsurance, though upgrades, additional days, and non-Medicare-covered stays are not covered. For acute hospital stays, there is a $395 copay per day for days 1 through 5 and no copay for days 6 through 90, while psychiatric stays require a $370 copay per day for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Wellcare Giveback (HMO) covers outpatient services with no coinsurance, featuring copays of $0 to $350 for outpatient hospital services, $115 to $350 per stay for observation services, and $225 for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellcare Giveback (HMO) with a $105.00 copayment and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO) covers Medicare-covered ground and air ambulance services with a $265 copay per service and no coinsurance, subject to prior authorization. Transportation services are not covered.
Emergency Services See details
Wellcare Giveback (HMO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance for emergency and urgent care, while worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback (HMO) offers primary care physician services and select telehealth benefits with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Additional covered services like physical therapy, occupational therapy, and mental health sessions have copays ranging from $35 to $40 with no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Giveback (HMO) preventive services are covered with no copay and no coinsurance for annual physicals, memory fitness, alternative therapies, and remote access, while kidney disease education requires no copay but a 20% coinsurance. Additional preventive benefits are partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling. Other covered services like glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs also carry no copay and no coinsurance.
Hearing Services See details
Wellcare Giveback (HMO) offers partially covered hearing services, featuring a $50 copay and no coinsurance for Medicare-covered exams, while annual routine exams and fitting evaluations have no copay or coinsurance. Prescription hearing aids are covered up to $350 per ear annually with no copay or coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Giveback (HMO) vision services are partially covered, as other eye exam services are not covered. Covered routine eye exams and eyewear, including contacts and glasses, feature no copay and no coinsurance, though overall eye exams may require a copay of up to $50 with no coinsurance, and eyewear is subject to a $100 annual limit.
Dental Services See details
Wellcare Giveback (HMO) partially covers dental services, offering preventive and diagnostic care with no copay and no coinsurance, while Medicare-covered dental services require a $50 copay and no coinsurance. Prior authorization is required for covered benefits, but several services including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Giveback (HMO) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellcare Giveback (HMO) covers dialysis services 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. Diabetic supplies feature no copay, while diabetic therapeutic shoes or inserts carry a 20% coinsurance, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Wellcare Giveback (HMO) covers diagnostic and radiological services with prior authorization required, featuring no coinsurance and no copay for lab services, and a $0 to $30 copay with no coinsurance for diagnostic tests. Radiological services include diagnostic radiology with a $0 minimum copay and no coinsurance, outpatient X-rays with a $50 copay and coinsurance, and therapeutic radiology with a copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Wellcare Giveback (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Giveback (HMO) features no coinsurance and no copay for overall Cardiac Rehabilitation Services; however, while some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copayments ranging from $20.00 to $40.00.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Giveback (HMO) with no coinsurance, featuring no copay for days 1 to 20 and days 61 to 100, and a $218 daily copay for days 21 to 60. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered in practice under the Wellcare Giveback (HMO) plan, as supplemental benefits such as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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