A non-government entity
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 $124.00. 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:
Sign up for Wellcare Giveback (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Giveback (HMO) Medicare prescription drug plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when using preferred pharmacies or preferred mail-order services, as well as no copay for Tier 6 (Select Care Drugs) across all pharmacy types. Standard pharmacies and standard mail-order services are also available for Tier 1 and Tier 2 drugs with copays ranging from $5 to $30. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 (Preferred Brand) and Tier 5 (Specialty) medications require a 25% coinsurance. Tier 4 (Non-Preferred) drugs carry a 42% coinsurance at preferred pharmacies and mail-order, and a 43% coinsurance at standard pharmacies and mail-order.
Additional Benefits
The Wellcare Giveback (HMO) plan offers affordable everyday healthcare with no copay and no coinsurance for primary care doctor visits, while specialist visits require a 50 dollar copay. For inpatient hospital stays, members pay no coinsurance, though daily copays of 375 dollars apply for the first six days of acute care. Outpatient hospital services also feature no coinsurance, with copays ranging from no copay up to 400 dollars depending on the service. Preventive care, routine vision exams, and preventive dental services are covered with no copay and no coinsurance, alongside a 100 dollar annual eyewear allowance. Routine hearing exams and hearing aids are also covered with no copay, while durable medical equipment requires no copay and a 20 percent coinsurance. However, this plan does not cover over-the-counter items, meal benefits, or restorative and orthodontic dental services.
Inpatient Hospital See details
Inpatient hospital services are covered by Wellcare Giveback (HMO) with no coinsurance, requiring a $375 daily copay for days 1 to 6 of acute stays and a $370 daily copay for days 1 to 5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Giveback (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $400 for outpatient hospital services and $115 to $400 per stay for observation services. Ambulatory surgical center services require a $250 copay with no coinsurance, while outpatient substance abuse sessions have a $25 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
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 covered benefit.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO) covers ground and air ambulance services with a $210 copay and no coinsurance, though prior authorization is required. For transportation, some services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Wellcare Giveback (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback (HMO) covers primary care physician visits with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Additional benefits like physical therapy ($40 copay) and mental health services ($25 copay) also feature no coinsurance. Some chiropractic services are covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered, and podiatry services are not covered.
Preventive Services See details
Wellcare Giveback (HMO) covers preventive services, including annual physicals, alternative therapies, fitness benefits, and remote access with no copay and no coinsurance, while kidney disease education has no copay and 20% coinsurance. Other screenings like glaucoma and diabetes training are covered with no copay and no 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 benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Wellcare Giveback (HMO), offering Medicare-covered exams for a $50 copay and no coinsurance, alongside annual routine exams, fitting evaluations, and prescription hearing aids (up to $350 per ear) with no copay or coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered under Wellcare Giveback (HMO), featuring no copay and no coinsurance for one routine annual eye exam, while other eye exam services are not covered. Eyewear is also covered with no copay, no coinsurance, and no deductible, up to a $100 annual combined maximum for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental Services are partially covered by Wellcare Giveback (HMO), with Medicare-covered services requiring a $50 copay and no coinsurance, and preventive services available with no copay and no coinsurance. Restorative, endodontic, periodontic, prosthodontic, oral surgery, implant, and orthodontic services are not covered under this plan.
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 are required. Under this benefit, Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 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, medical supplies, and diabetic therapeutic shoes or inserts with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, though prior authorization is required for equipment and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Giveback (HMO) covers diagnostic and radiological services, featuring no coinsurance and a $0 to $30 copay for diagnostic tests, alongside no copay for lab services. Radiological services require prior authorization and carry a $50 copay for outpatient X-rays, a 20% coinsurance for therapeutic radiology, and no copay for diagnostic radiology.
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
Cardiac Rehabilitation Services are covered by Wellcare Giveback (HMO) with no coinsurance, though only some services are covered as standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) 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 no prior three-day hospital stay. There is no copay for days 1 through 20 and days 61 through 100, and a $218 daily copay for days 21 through 60, up to the 100-day limit.
Other Services See details
Other services, such as acupuncture, over-the-counter (OTC) items, and meal benefits, are not covered under the Wellcare Giveback (HMO) plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved