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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 $2500.00 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 prescription drug deductible. Once this deductible is met, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies, while standard pharmacies require a $10 copay. Tier 2 standard generics and Tier 4 non-preferred drugs require a 25% coinsurance at both preferred and standard pharmacies. Tier 3 preferred brand drugs require a 32% coinsurance at preferred pharmacies and 33% at standard pharmacies, while Tier 5 specialty drugs have no copay. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, those who qualify for Extra Help will pay nothing for their Part D premium.
Additional Benefits
The Wellcare Simple (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, home health services, and routine preventive care. For hospital stays, beneficiaries pay a daily copay of $250 for days 1 to 10 of acute inpatient care and a $175 copay for partial hospitalization, both with no coinsurance. Outpatient services feature no coinsurance and variable copays, while emergency room visits require a $150 copay. This plan also includes valuable supplemental benefits, such as comprehensive dental care with no copay up to a $3,000 annual limit and eyewear coverage with no copay up to a $200 yearly limit. Routine hearing exams and hearing aids are available with no copay, though a $750 annual maximum per ear applies to prescription devices. Additionally, diabetic supplies and lab services require no copay, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO) partially covers inpatient hospital services with prior authorization, excluding additional days, non-Medicare-covered stays, and acute room upgrades. Acute stays require a $250 daily copay for days 1 to 10 and no copay for days 11 to 90, while psychiatric stays cost a $225 daily copay for days 1 to 10 and no copay for days 11 to 90, with no coinsurance for either benefit.
Outpatient Services See details
Wellcare Simple (HMO) covers outpatient services with no coinsurance, though copays vary depending on the specific service. Beneficiaries will pay no copay for outpatient blood services, $25 for outpatient substance abuse sessions, $175 for ambulatory surgical center visits, and between $0 and $275 for outpatient hospital and observation services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Wellcare Simple (HMO) with a $175 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Simple (HMO), though transportation to any health-related location is not covered. Ground and air ambulance services require a $350 copay and no coinsurance, while up to 12 plan-approved one-way transportation trips per year are available with no copay and no coinsurance.
Emergency Services See details
Emergency services are partially covered by Wellcare Simple (HMO), featuring a $150 copay and no coinsurance for emergency visits, and a $20 copay and no coinsurance for urgent care. Worldwide emergency and urgent care are also covered with a $150 copay up to a $50,000 maximum, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO) offers partially covered primary care benefits with no coinsurance, though podiatry services and routine chiropractic care are not covered. Covered services feature no copay for primary care provider visits, while other services like specialist visits, therapies, and mental health sessions require copays ranging from $0 to $25.
Preventive Services See details
Wellcare Simple (HMO) partially covers preventive services, offering annual exams, fitness benefits, alternative therapies, and screenings with no copays and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. Sub-services such as health education, in-home safety assessments, personal emergency response systems, 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, and additional smoking cessation counseling are not covered.
Hearing Services See details
Wellcare Simple (HMO) partially covers hearing services, featuring a $15 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams, fitting evaluations, and general prescription hearing aids. A $750 annual maximum per ear applies to prescription hearing aids, but OTC hearing aids, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Wellcare Simple (HMO) with no coinsurance and a $0 to $15 copay for eye exams, including one routine exam per year with no copay. Eyewear, including contacts and eyeglasses, is also covered with no copay or coinsurance up to a $200 annual maximum benefit.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO), with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Covered preventive and comprehensive dental services require no copay and no coinsurance up to a $3,000 annual maximum, while Medicare-approved dental services require a $15 copay and no coinsurance.
Home Infusion bundled Services See details
Wellcare Simple (HMO) covers home infusion bundled services, requiring prior authorization and offering Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other Part B chemotherapy, radiation, and general drugs are covered with no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Simple (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered by Wellcare Simple (HMO), with durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes requiring 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 prior authorization required. Lab services require no copay and no coinsurance, diagnostic tests have a $0 to $30 copay and no coinsurance, and diagnostic radiological services have a copay of $0 to $275 and no coinsurance. Outpatient X-rays carry a $50 copay with no coinsurance, while therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Home health services are covered by Wellcare Simple (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO) indicates that some services are covered, but in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. As a result, no copay or coinsurance details are available for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Wellcare Simple (HMO) with prior authorization, requiring no coinsurance and no copay for days 1 through 20 and days 41 through 100, while days 21 through 40 require a $218 daily copay. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO) partially covers Other Services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture and dual eligible SNPs with highly integrated services are not covered.
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