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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 $7500.00 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. After the 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 and mail order, and a $10 copay at standard pharmacies. For specialty drugs, the copay is $10, regardless of the pharmacy.
Additional Benefits
The Wellcare Specialty Simple (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $250 copay for days 1-7, and no copay for days 8-90. Outpatient services, including primary care, have copays ranging from $0 to $275. The plan also covers ambulance services, emergency services, and several therapies with associated copays. Preventive services, including an annual physical exam, and many vision and dental services are covered with no copay. The plan also covers hearing exams, hearing aids, and medical equipment with varying costs.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered with prior authorization. For days 1-7, there is a $250 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $275, Observation Services with a copay between $110 and $275, Ambulatory Surgical Center (ASC) Services with a $225 copay, and Outpatient Substance Abuse Services with a $25 copay for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Specialty Simple (HMO C-SNP) plan, with a copay of $80.00. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $350 copay, and transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, have a $110 copay and no coinsurance, while Urgently Needed Services have a $10 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care services are covered with no copay. Chiropractic services have a $15 copay, but routine care is not covered. Occupational therapy services have a $30 copay, and physician specialist services have a $25 copay. Mental health specialty services and podiatry services have a $25 copay, while other health care professional services have a copay between $0 and $25. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a copay between $0 and $30. Opioid treatment program services also have a $25 copay.
Preventive Services See details
The Wellcare Specialty Simple (HMO C-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Remote Access Technologies, Personal Emergency Response System (PERS), and Alternative Therapies, all with no copay.
Hearing Services See details
The Wellcare Specialty Simple (HMO C-SNP) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $750 per year, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The Wellcare Specialty Simple (HMO C-SNP) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $25, with routine eye exams having no copay. Eyewear has no copay, with a combined maximum benefit of $100 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Wellcare Specialty Simple (HMO C-SNP) covers Medicare dental services with a $25 copay, and other dental services including oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, and other preventive services with no copay. Restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery are covered with a 40% coinsurance, and orthodontics has a maximum benefit of $1500 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, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Specialty Simple (HMO C-SNP) plan. You are responsible for 20% coinsurance.
Medical Equipment See details
The Wellcare Specialty Simple (HMO C-SNP) plan covers medical equipment including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic supplies and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with no copay, lab services with no copay, and outpatient X-ray services with a $75 copay. Diagnostic Radiological Services have a copay up to $275, and therapeutic radiological services have a 20% coinsurance.
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, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Specialty Simple (HMO C-SNP) plan, though specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for some services, but specific copay information is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization required. There is no copay for days 1-20 and 61-100, but there is a $214 copay for days 21-60.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, which have no copay, and a meal benefit, which also has no copay, but requires a doctor's referral. 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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