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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 $105.00. 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 has an annual drug deductible of $615. You can save on coverage with no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or preferred mail order. Additionally, Tier 6 select care drugs have no copay at any standard or preferred pharmacy. For brand-name and specialty medications, costs are based on coinsurance. Tier 3 preferred brand drugs and Tier 5 specialty drugs both require a 25% coinsurance, while Tier 4 non-preferred drugs have a 50% coinsurance. If you choose to use a standard pharmacy, copays for Tier 1 and Tier 2 generics start as low as $5 and $10, respectively.
Additional Benefits
The Wellcare Giveback (HMO) plan offers affordable access to everyday medical care, featuring no copays or coinsurance for primary care doctor visits and routine preventive services. For specialized care, members will pay a $50 copay for specialists, while inpatient hospital stays require a $370 daily copay for the first several days before transitioning to no copay. Emergency room visits carry a $115 copay, and outpatient services are covered with fixed copays and no coinsurance. This plan also includes essential support for dental, vision, and hearing needs, offering routine exams and preventive dental care with no copays or coinsurance. Additionally, home health services are fully covered with no copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. While prescription hearing aids and eyewear are partially covered, other benefits like routine transportation, over-the-counter items, and acupuncture are not covered.
Inpatient Hospital See details
Wellcare Giveback (HMO) offers inpatient hospital care with no coinsurance, though it is only partially covered as upgrades, additional days, and non-Medicare-covered stays are not covered. Medicare-approved acute stays require a $370 daily copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays require a $370 daily copay for days 1 through 5 and no copay for days 6 through 90, with prior authorization required for both.
Outpatient Services See details
Wellcare Giveback (HMO) covers outpatient services with no coinsurance, though copays apply to most services. Outpatient hospital visits have a copay of $0 to $350, ambulatory surgical center services require a $225 copay, and outpatient substance abuse sessions cost a $25 copay, while outpatient blood services feature no copay.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Giveback (HMO) with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO) covers ground and air ambulance services with a $235 copay per service and no coinsurance, although prior authorization is required. Routine transportation services to plan-approved or other 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 $30 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under Wellcare Giveback (HMO) offer primary care physician services with no copay and no coinsurance, while specialist visits require a $50 copay with no coinsurance. Other covered services range from a $25 to $45 copay with no coinsurance for mental health and therapy services, though chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Giveback (HMO) covers preventive services with no copay and no coinsurance for annual physical exams, alternative therapies, memory fitness, remote access technologies, and other screenings, while kidney disease education has no copay and a 20% coinsurance. Additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling services.
Hearing Services See details
Wellcare Giveback (HMO) provides hearing services with no deductible, including Medicare-covered exams for a $50 copay and no coinsurance, alongside annual routine exams and fittings with no copay or coinsurance. Prescription hearing aids are partially 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) partially covers vision services with no coinsurance and no deductibles, though prior authorization is required. Routine eye exams are covered with no copay once per year, but other eye exam services are not covered, while eyewear is covered with no copay up to a $100 annual maximum.
Dental Services See details
Wellcare Giveback (HMO) covers Medicare-covered dental services with a $50 copay and no coinsurance, and preventive dental services with no copay and no coinsurance. Dental services are only partially covered, with no coverage provided for restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Wellcare Giveback (HMO) covers Home Infusion bundled Services with no copay, subject to prior authorization and step therapy requirements. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Giveback (HMO) 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 are covered with no copay and no coinsurance, while diabetic therapeutic shoes or inserts are covered with no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Giveback (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures have no coinsurance and a $0 to $30 copay, lab services have no copay, and radiological services range from a $0 minimum copay for diagnostic imaging to a $50 copay plus coinsurance for X-rays and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Wellcare Giveback (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Giveback (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. These non-covered services require copays of $30, $40, $25, and $20, respectively.
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 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 covered by the Wellcare Giveback (HMO), meaning some services are covered, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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