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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 $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 Specialty Simple (HMO C-SNP) plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, Tier 1 preferred generic drugs have no copay at preferred pharmacies and a $10.00 copay at standard pharmacies. Tier 2 standard generics and Tier 4 non-preferred drugs require a 25% coinsurance, while Tier 3 preferred brands carry a 37% coinsurance at preferred pharmacies and 38% at standard pharmacies. In the initial coverage phase, Tier 5 specialty drugs are also available with no copay at both preferred and standard pharmacies. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. For those who qualify for the full Low-Income Subsidy (LIS), the plan's Part D premium is reduced to $0.00.
Additional Benefits
The Wellcare Specialty Simple (HMO C-SNP) plan offers robust coverage with many essential healthcare services available at little to no cost. Members benefit from no copay for primary care doctor visits, routine eye and hearing exams, preventive dental care, and home health services. When specialized care is needed, specialist visits and physical therapy feature low copays ranging from $0 to $30, while emergency room visits require a $115 copay. This plan also includes valuable everyday wellness benefits to help you manage your health and budget. You can access over-the-counter items, fitness programs, and up to 24 one-way trips to plan-approved locations with no copay. Additionally, the plan covers prescription hearing aids and eyewear with no copay up to specified annual limits, alongside comprehensive dental services that require 40% coinsurance.
Inpatient Hospital See details
Wellcare Specialty Simple (HMO C-SNP) partially covers inpatient hospital benefits, requiring a $250 daily copay for days 1 to 7 and no copay or coinsurance for days 8 to 90 for acute and psychiatric stays. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, but up to 10 additional acute care days are provided with no copay.
Outpatient Services See details
Outpatient services are covered by Wellcare Specialty Simple (HMO C-SNP) with no coinsurance, featuring copays ranging from no copay to $275 for outpatient hospital services and $115 to $275 per stay for observation services. Patients will pay a $225 copay for ambulatory surgical center services, a $25 copay for outpatient substance abuse sessions, and no copay or deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Wellcare Specialty Simple (HMO C-SNP) with a copay of $105.00 and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Wellcare Specialty Simple (HMO C-SNP) partially covers ambulance and transportation services, with ground and air ambulance services requiring a $350 copay and no coinsurance. Transportation to plan-approved locations is covered with no copay and no coinsurance for up to 24 one-way trips per year, 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 $115 copay and urgently needed services with a $10 copay, with no coinsurance for either benefit. Worldwide emergency services are partially covered up to a $50,000 maximum benefit with a $115 copay and no coinsurance, but 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. Other services, including specialist visits, physical therapy, and mental health services, feature copays ranging from $0 to $30 and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, but routine chiropractic care is not covered.
Preventive Services See details
Wellcare Specialty Simple (HMO C-SNP) offers partial coverage for preventive services, featuring no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and kidney disease education. However, several sub-services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Specialty Simple (HMO C-SNP) partially covers hearing services, offering hearing exams for a $25 copay (with no copay for routine exams and fittings) and prescription hearing aids with no copay, both with no coinsurance and up to a $750 annual limit per ear. However, OTC hearing aids, as well as prescription hearing aids for the inner ear, outer ear, and over the ear, are not covered.
Vision Services See details
Vision services are covered by Wellcare Specialty Simple (HMO C-SNP) with no coinsurance, offering one annual routine eye exam with no copay and other eye exams with a $0 to $25 copay. Covered eyewear, including contacts and eyeglasses, also features no copay and no coinsurance up to a $100 combined annual limit.
Dental Services See details
Wellcare Specialty Simple (HMO C-SNP) partially covers dental services, offering preventive care like cleanings and exams with no copay and no coinsurance, and Medicare dental services for a $25 copay and no coinsurance. Comprehensive services like restorative care and periodontics require no copay and 40% coinsurance up to a $1,500 annual maximum, while prosthodontics, implants, maxillofacial prosthetics, and orthodontics 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. 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 Specialty Simple (HMO C-SNP) plan with 20% coinsurance and no copay.
Medical Equipment See details
Medical Equipment benefits are covered by Wellcare Specialty Simple (HMO C-SNP), though prior authorization is required. Durable medical equipment, prosthetics, and medical supplies require a 20% coinsurance and no copay, while diabetic supplies and therapeutic shoes or inserts are available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Specialty Simple (HMO C-SNP), with no copay or coinsurance for lab services and diagnostic tests. Outpatient X-rays require a $50 copay and no coinsurance, diagnostic radiology has a copay of $0 to $275 and no coinsurance, and therapeutic radiology has a 20% coinsurance with no copay.
Home Health Services See details
Wellcare Specialty Simple (HMO C-SNP) 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 Specialty Simple (HMO C-SNP) plan, which includes cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services. Because these services are not covered by the plan, there are no copayments or coinsurance options available for patients.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Wellcare Specialty Simple (HMO C-SNP), with prior authorization required and additional days beyond Medicare-covered limits not covered. For covered stays, there is no coinsurance, with no copay for days 1 to 20 and 71 to 100, and a $218 daily copay for days 21 to 70.
Other Services See details
Wellcare Specialty Simple (HMO C-SNP) provides partial coverage for other services, offering over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and Dual Eligible SNP services are not covered under this plan, and a doctor referral is required to access the meal benefit.
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