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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 2025, 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 out of 5 stars in 2025.
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 $420.00 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) plan has a $420 deductible for prescription drugs. In the initial coverage phase, after you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred pharmacies or preferred mail order. Standard generic drugs have 25% coinsurance, while preferred brand drugs have 35% coinsurance. Specialty tier drugs have no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Specialty Simple (HMO C-SNP) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a $250 copay for the first 5 days, and then no copay, while outpatient services and primary care visits have copays ranging from $0 to $250. The plan also includes benefits such as no copay for preventive services, vision, and dental services, as well as a meal benefit. This plan also covers services like ambulance, hearing, and home health services with varying copays or coinsurance amounts. Additionally, it provides coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility stays with differing cost-sharing structures. There are also several services that are not covered, so be sure to review the details in the plan summary.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Wellcare Specialty Simple (HMO C-SNP) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you'll pay a $250 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services, are covered by the Wellcare Specialty Simple (HMO C-SNP) plan. Outpatient hospital services have a copay between $0 and $250, observation services have a copay between $140 and $250, and ambulatory surgical center (ASC) services have a $250 copay. Individual and group sessions for outpatient substance abuse have a copay of $15, and outpatient blood services have no copay.
Partial Hospitalization See details
Wellcare Specialty Simple (HMO C-SNP) covers partial hospitalization with a $130 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Specialty Simple (HMO C-SNP) plan. Ground and air ambulance services have a $285 copay, with no coinsurance, while transportation services to a plan-approved health-related location have no copay and no coinsurance, for up to 24 one-way trips per year; transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare Specialty Simple (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services have a $10 copay; all of these services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Specialty Simple (HMO C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $15 copay (prior authorization required), occupational therapy services with a $15 copay (prior authorization required), physician specialist services with a $15 copay (prior authorization required), mental health specialty services with a $15 copay for individual and group sessions (prior authorization required), podiatry services with a $15 copay (prior authorization required), other health care professional services with a copay between $0 and $15 (prior authorization required), psychiatric services with a $15 copay for individual and group sessions (prior authorization required), physical therapy and speech-language pathology services with a $15 copay (prior authorization required), additional telehealth benefits with a copay between $0 and $15 (prior authorization required), and opioid treatment program services with a $15 copay (prior authorization required). Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services including fitness benefits, remote access technologies, alternative therapies, personal emergency response systems, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Other services like health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $15 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay; prescription hearing aids (all types) have no copay, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Specialty Simple (HMO C-SNP) plan covers vision services, including eye exams with a copay of $0-$15, and eyewear with no copay and a combined maximum benefit of $100 per year. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $15 copay, and other dental services such as oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery are covered with 40% coinsurance, and orthodontic services are covered up to $2000 per year. Prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Specialty Simple (HMO C-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Specialty Simple (HMO C-SNP) plan, with Durable Medical Equipment (DME) subject to 20% coinsurance and Prosthetic Devices and Medical Supplies covered with 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $250, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a copay of $75.
Home Health Services See details
Home Health Services are covered by the Wellcare Specialty Simple (HMO C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Specialty Simple (HMO C-SNP) plan. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Specialty Simple (HMO C-SNP) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-50, the copay is $214, and for days 51-100, there is no copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Specialty Simple (HMO C-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and also covers a Meal Benefit with no copay and a doctor referral required. Other services such as Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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