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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 AZ. This plan received an overall rating of 3.5 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 $29.00. 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 $9250.00 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) plan features an enhanced alternative drug benefit with a $615.00 prescription drug deductible. After meeting this deductible, you enter the initial coverage phase where Tier 1 preferred generics have no copay at preferred pharmacies and a $10.00 copay at standard pharmacies. During this phase, Tier 2 standard generics and Tier 4 non-preferred drugs require a 25% coinsurance, Tier 3 preferred brands require a 44% coinsurance, and Tier 5 specialty drugs have no copay at either preferred or standard pharmacies. Once 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, individuals who qualify for the low-income subsidy or Extra Help will pay nothing for their Part D coverage. You can check the plan's formulary to see how your specific prescription drugs are covered under these tiers.
Additional Benefits
The Wellcare Giveback (HMO) plan offers affordable coverage for your essential healthcare needs, featuring no copay and no coinsurance for primary care visits, routine vision care, and routine dental exams. If you require hospital care, inpatient stays feature a set copay for the first six days followed by no copay, while emergency room visits carry a $115 copay. Outpatient services and diagnostic lab tests are also highly accessible, often requiring no copay or minimal copays depending on the procedure. For specialized medical needs, skilled nursing facility stays and home health services are available with no copay for initial care periods. Specialized services like comprehensive dental, dialysis, and durable medical equipment are covered with a coinsurance and no copay. However, it is important to note that this plan does not cover certain benefits, including cardiac rehabilitation, routine transportation, and over-the-counter items.
Inpatient Hospital See details
Wellcare Giveback (HMO) inpatient hospital benefits are partially covered, with acute care requiring a $400 copay for days 1-6 and psychiatric care requiring a $325 copay for days 1-6. Both services feature no copay for days 7-90 and no coinsurance, though upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Giveback (HMO) with no coinsurance, featuring copays ranging from no copay to $375 for hospital services and a $300 copay for ambulatory surgical center visits. Additionally, outpatient substance abuse sessions require a $25 copay, while outpatient blood services are covered with no copay.
Partial Hospitalization See details
Wellcare Giveback (HMO) covers partial hospitalization benefits with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO) partially covers ambulance and transportation services, but transportation to plan-approved or any health-related locations is not covered. Covered ground and air ambulance services require prior authorization and have a $300 copay with no coinsurance.
Emergency Services See details
Emergency services are partially covered by Wellcare Giveback (HMO) because worldwide emergency transportation is not covered. Covered emergency services require a $115 copay and no coinsurance, urgently needed services have a $40 copay and no coinsurance, and worldwide emergency and urgent care are covered up to $50,000 with a $115 copay and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Wellcare Giveback (HMO), offering no copay and no coinsurance for primary care physician visits, and copays between $0 and $50 with no coinsurance for other covered services. Podiatry services and routine chiropractic care are not covered under this plan.
Preventive Services See details
Wellcare Giveback (HMO) partially covers preventive services, offering annual physical exams, fitness benefits, alternative therapies, and glaucoma screenings with no copays and no coinsurance. Kidney disease education is covered with a 20% coinsurance and no copay. However, sub-services such as health education, weight management, counseling, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, and safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Giveback (HMO) with no deductible, offering Medicare-covered exams for a $50 copay and no coinsurance, while routine exams and fittings have no copay or coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $500 annual maximum per ear, though OTC hearing aids and inner, outer, and over-the-ear prescription aids are not covered.
Vision Services See details
Wellcare Giveback (HMO) covers routine eye exams and eyewear, including contacts and eyeglasses, with no copay and no coinsurance, up to a $100 annual limit. Other eye exams require a copay of $0 to $50 with no coinsurance, and prior authorization is required for vision services.
Dental Services See details
Wellcare Giveback (HMO) partially covers dental services, offering preventive care like exams and cleanings with no copay and no coinsurance, while Medicare dental services require a $50 copay and no coinsurance. Covered comprehensive services, including restorative and endodontic care, have a 40% coinsurance and no copay up to a $1,000 annual limit, but implants, orthodontics, and prosthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Wellcare Giveback (HMO) plan, subject to prior authorization and step therapy. 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 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Wellcare Giveback (HMO) plan, which features a 20% coinsurance and no copay for these treatments.
Medical Equipment See details
Wellcare Giveback (HMO) covers medical equipment, including durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts, for a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Giveback (HMO) covers diagnostic and radiological services, with prior authorization required for these benefits. Diagnostic procedures, tests, and lab services have no copay or coinsurance, while outpatient X-rays require a $50 copay and no coinsurance, diagnostic radiological services range from no copay up to a $375 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Wellcare Giveback (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Giveback (HMO) plan. Although the plan indicates some services are covered, in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Giveback (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization, though additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and days 71 to 100, while days 21 to 70 require a $218 copay per day.
Other Services See details
Other Services are not covered under the Wellcare Giveback (HMO) plan, which provides no coverage for acupuncture, over-the-counter (OTC) items, meal benefits, or highly integrated dual eligible SNP services.
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