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Wellcare Specialty Simple (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Specialty Simple (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Specialty Simple (HMO C-SNP) in 2026, please refer to our full plan details page.
Wellcare Specialty Simple (HMO C-SNP) is a HMO C-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in AZ. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Specialty Simple (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Specialty Simple (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Specialty Simple (HMO C-SNP).
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 Specialty Simple (HMO C-SNP), 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $3450.00 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 Specialty Simple (HMO C-SNP) prescription drug plan features an annual deductible of $615.00 before initial coverage begins. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies and no copay for Tier 5 specialty drugs at both preferred and standard pharmacies. Other tiers require coinsurance, including 25% for Tier 2 standard generics and Tier 4 non-preferred drugs, and up to 44% for Tier 3 preferred brands. Once your total yearly out-of-pocket drug costs reach $2,100.00, you will enter the catastrophic coverage phase. During this phase, you pay nothing for covered Medicare Part D prescription drugs. If you qualify for the low-income subsidy, your Part D costs may be reduced to $0.00.
Additional Benefits
The Wellcare Specialty Simple (HMO C-SNP) offers robust healthcare coverage with predictable costs, featuring no copay and no coinsurance for primary care, preventive care, and home health services. Inpatient hospital stays require a $250 daily copay for days one through five, followed by no copay for days six through ninety. Outpatient procedures, emergency services, and specialist visits are also covered, with copays generally ranging from low flat fees to set maximums and no coinsurance. Beyond standard medical care, this plan provides valuable extra benefits including dental, vision, and hearing coverage, with no copay for preventive dental services, routine eye exams, and prescription hearing aids up to $750 per ear. Members also benefit from up to 24 one-way transportation trips, over-the-counter items, and home meals with no copay or coinsurance. While certain services like dialysis and durable medical equipment require a 20% coinsurance, the plan keeps routine and preventive health services exceptionally affordable.
Inpatient Hospital See details
Wellcare Specialty Simple (HMO C-SNP) partially covers inpatient hospital services, featuring a $250 copay per day for days 1 through 5, no copay for days 6 through 90, and no coinsurance for covered acute and psychiatric stays. Sub-services such as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Specialty Simple (HMO C-SNP) covers outpatient services with no coinsurance, offering no copay for outpatient blood services and a $15 copay for outpatient substance abuse sessions. Copays for other services range from $0 to $250 for outpatient hospital services, $150 to $250 for observation services, and $250 for ambulatory surgical center services.
Partial Hospitalization See details
Wellcare Specialty Simple (HMO C-SNP) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required for these benefits.
Ambulance and Transportation Services See details
Wellcare Specialty Simple (HMO C-SNP) covers ground and air ambulance services with a $285 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Specialty Simple (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $10 copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 limit with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Specialty Simple (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while other services like specialist visits, therapy, and telehealth require a copay ranging from $0 to $15 and no coinsurance. Chiropractic services are only partially covered under this plan, as routine chiropractic care is not covered.
Preventive Services See details
Wellcare Specialty Simple (HMO C-SNP) partially covers preventive services with no copay and no coinsurance for covered options such as annual physical exams, fitness benefits, and screenings. Sub-services that are not covered under this plan include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, home safety modifications, and counseling services.
Hearing Services See details
Hearing services are partially covered by Wellcare Specialty Simple (HMO C-SNP) with no deductible and no coinsurance. Medicare-covered exams require a $15 copay, while routine exams, fitting evaluations, and prescription hearing aids (all types) have no copay, up to a $750 annual limit per ear. Inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Specialty Simple (HMO C-SNP) covers vision services with no coinsurance, offering eye exams with a $0 to $15 copay and eyewear with no copay. Routine eye exams are limited to one per year, and there is a combined maximum eyewear benefit of $100 annually.
Dental Services See details
Wellcare Specialty Simple (HMO C-SNP) partially covers dental services, offering preventive care like cleanings and exams with no copay or coinsurance, and Medicare dental services for a $15 copay and no coinsurance. Covered comprehensive services such as restorative, endodontics, periodontics, and oral surgery require a 40% coinsurance and no copay up to a $2,000 annual maximum, while implants, orthodontics, maxillofacial prosthetics, and prosthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Specialty Simple (HMO C-SNP) with prior authorization required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Wellcare Specialty Simple (HMO C-SNP) covers dialysis services with a 20% coinsurance and no copay. This coverage ensures you receive essential kidney dialysis treatments with clear, predictable out-of-pocket costs.
Medical Equipment See details
Wellcare Specialty Simple (HMO C-SNP) covers medical equipment, offering durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies and therapeutic shoes or inserts are also covered with no copay and no coinsurance, though prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Specialty Simple (HMO C-SNP), with prior authorization required. Members pay no copay or coinsurance for diagnostic tests, lab services, and outpatient X-rays, while diagnostic radiological services require a copay of $0 to $250 and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home health services are covered by Wellcare Specialty Simple (HMO C-SNP) with no copay and no coinsurance. Prior authorization is required to access these covered home health benefits.
Cardiac Rehabilitation Services See details
Wellcare Specialty Simple (HMO C-SNP) does not cover Cardiac Rehabilitation Services. In practice, all associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services, are not covered by this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Wellcare Specialty Simple (HMO C-SNP) with no coinsurance, though prior authorization is required. There is no copay for days 1 to 20 and days 41 to 100, a $218 daily copay for days 21 to 40, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Specialty Simple (HMO C-SNP) partially covers Other Services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered, and the meal benefit requires a doctor referral.
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