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Wellcare Simple (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple (HMO) in 2026, please refer to our full plan details page.
Wellcare Simple (HMO) is a HMO 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 Simple (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 Simple (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 Simple (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.
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 $7000.00 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 Simple (HMO) plan features an Enhanced Alternative drug benefit with a $615.00 prescription drug deductible. Once this deductible is met, you enter the initial coverage phase where Tier 1 preferred generics have no copay at preferred pharmacies, and Tier 5 specialty drugs have no copay at both preferred and standard pharmacies. Other tiers require coinsurance, such as 25% for standard generics and non-preferred drugs, and up to 35% for preferred brand drugs. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, members who qualify for the Extra Help low-income subsidy will have their Part D premium reduced to $0.00.
Additional Benefits
The Wellcare Simple (HMO) plan offers affordable healthcare coverage featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For inpatient hospital stays, members pay a daily copay of $325 for days 1 through 6, with no copay for days 7 through 90, while outpatient hospital visits range from no copay up to a $275 copay. Emergency care is available with a $115 copay, and urgent care requires a $40 copay, both with no coinsurance. Ancillary benefits include routine dental, vision, and hearing exams with no copay, alongside eyewear covered up to $100 annually with no coinsurance. Prescription hearing aids are partially covered up to $500 per ear annually with no copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Additionally, the plan covers up to 12 one-way transportation trips per year to approved locations and select over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Wellcare Simple (HMO) and require a $325 daily copay for days 1 to 6, no copay for days 7 to 90, and no coinsurance for both acute and psychiatric stays. Prior authorization is required, and the plan does not cover additional days, non-Medicare-covered stays, or acute care upgrades.
Outpatient Services See details
Wellcare Simple (HMO) covers outpatient services with no coinsurance, featuring copays of $0 to $275 for outpatient hospital visits, $115 to $275 per stay for observation services, and $225 for ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay, while outpatient blood services are covered with no copay.
Partial Hospitalization See details
Wellcare Simple (HMO) covers partial hospitalization benefits with a copay of $105.00 and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Wellcare Simple (HMO) covers ground and air ambulance services with a $350 copay and no coinsurance per trip, requiring prior authorization. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Wellcare Simple (HMO) with a $115 copay and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 lifetime limit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO) covers primary care physician services with no copay and no coinsurance, while other services like specialists, mental health, and therapy require copays up to $40 and no coinsurance. Chiropractic services are partially covered because routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Wellcare Simple (HMO), offering annual physicals, glaucoma screenings, diabetes training, and select supplemental benefits like fitness programs for no copay and no coinsurance. Kidney disease education is covered with a 20% coinsurance and no copay, but several services—including 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, smoking cessation, counseling, and safety devices—are not covered.
Hearing Services See details
Wellcare Simple (HMO) covers Medicare-covered hearing exams with a $25 copay and no coinsurance, while annual routine exams and fitting evaluations feature no copay, no deductible, and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO) covers annual routine eye exams with no copay and other eye exams with a copay of $0 to $25, with no coinsurance or deductibles required. Eyewear, including lenses, frames, and contacts, is also covered with no copay and no coinsurance up to a combined maximum benefit of $100 per year.
Dental Services See details
Wellcare Simple (HMO) partially covers dental services, with no coverage for maxillofacial prosthetics, implant services, and orthodontics. Covered Medicare dental services require a $25 copay and no coinsurance, while other covered preventive and comprehensive services feature no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple (HMO) with prior authorization, offering Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation, require no copay and feature coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Simple (HMO) with a 20% coinsurance and no copay.
Medical Equipment See details
Wellcare Simple (HMO) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, though prior authorization is required for most medical equipment and supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO) with no copay for lab services, a $0 to $50 copay for diagnostic tests, and a $50 copay for outpatient X-rays, all with no coinsurance. Diagnostic radiological services feature a copay of $0 to $275 with no coinsurance, while therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Wellcare Simple (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Simple (HMO) plan, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered. Consequently, there is no copay or coinsurance coverage available for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Wellcare Simple (HMO) with no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20 and days 61 through 100, while days 21 through 60 require a $218 daily copay.
Other Services See details
Wellcare Simple (HMO) partially covers Other Services, offering over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit.
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