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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 $84.00. 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 $7600.00 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) prescription drug plan features an annual drug deductible of $615.00. 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. Tier 2 standard generics and Tier 4 non-preferred drugs require a 25% coinsurance, Tier 3 preferred brands require a 43% coinsurance, and Tier 5 specialty drugs have 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 Part D drugs. Additionally, if you qualify for the low-income subsidy, your Part D premium may be reduced to $0.00.
Additional Benefits
The Wellcare Giveback (HMO) plan focuses on affordable everyday care by offering no copay and no coinsurance for primary care doctor visits and routine preventive screenings. Specialist visits and urgent care services are available with a standard $40 copay, while emergency room visits require a $115 copay. For hospital care, inpatient stays require a daily copay for the first six days of a stay, with no copay required for days seven through ninety. This plan also covers routine dental, vision, and hearing services with no copay for annual exams, alongside allowances for eyewear and prescription hearing aids. Home health services are fully covered with no copay, while durable medical equipment and dialysis require a 20% coinsurance. Note that some benefits, including transportation, over-the-counter items, and cardiac rehabilitation, are not covered under this plan.
Inpatient Hospital See details
Wellcare Giveback (HMO) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $400 for days 1-6 of acute stays (no copay for days 7-90) and $325 for days 1-6 of psychiatric stays (no copay for days 7-90). Additional days, upgrades, and non-Medicare-covered stays are not covered under these benefits.
Outpatient Services See details
Wellcare Giveback (HMO) covers outpatient hospital services with a 20% coinsurance and a copay ranging from no copay to $250, alongside outpatient observation services with a 20% coinsurance and a $115 copay. Ambulatory surgical center services are covered with a $200 copay and no coinsurance, outpatient substance abuse sessions require a $25 copay and no coinsurance, and outpatient blood services are provided with no copay or coinsurance.
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 covered services.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO) partially covers ambulance and transportation services, with ground and air ambulance services requiring a $295 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Wellcare Giveback (HMO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are covered by Wellcare Giveback (HMO) with no copay and no coinsurance for primary care provider visits. Specialist visits require a $40 copay, therapy services cost a $35 copay, and mental health sessions have a $25 copay with no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Wellcare Giveback (HMO), featuring no copay and no coinsurance for annual physical exams, fitness benefits, and routine screenings. Kidney disease education is covered with a 20% coinsurance and no copay, while sub-services such as health education, weight management, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered by Wellcare Giveback (HMO), featuring no copay or coinsurance for annual routine exams and fitting evaluations, and a $40 copay with no coinsurance for Medicare-covered exams. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual limit per ear, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Giveback (HMO) covers vision services with no deductible and no coinsurance, offering one annual routine eye exam with no copay and other exams with a copay of up to $40. Eyewear is also covered with no copay and no coinsurance up to a combined maximum of $100 per year, though prior authorization is required.
Dental Services See details
Wellcare Giveback (HMO) partially covers dental services, offering Medicare-covered dental care for a $40 copay and no coinsurance, and preventive and adjunctive services with no copay and no coinsurance. Restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implants, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Wellcare Giveback (HMO) and require prior authorization, with some drugs subject to step therapy. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Wellcare Giveback (HMO) covers dialysis services with no copay and a 20% coinsurance. This benefit ensures you have access to necessary kidney dialysis treatments with clear and predictable out-of-pocket costs.
Medical Equipment See details
Wellcare Giveback (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic therapeutic shoes, with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, though prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Wellcare Giveback (HMO) with prior authorization required. Members pay no copay for lab services, a $30 copay for outpatient x-rays, $0 to $40 for diagnostic tests, and up to a $250 copay for diagnostic radiology, all with no coinsurance, while therapeutic radiology requires 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
Wellcare Giveback (HMO) notes that some services are covered under Cardiac Rehabilitation, but in practice, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation sub-services are not covered. Consequently, there is no copay or coinsurance, and members must pay the full cost for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered under the Wellcare Giveback (HMO) plan, as additional days beyond the Medicare-covered limit are not covered. There is no coinsurance for these services, which feature no copay for days 1 through 20 and days 71 through 100, and a $218 daily copay for days 21 through 70.
Other Services See details
Other Services are not covered under the Wellcare Giveback (HMO) plan, which excludes acupuncture, over-the-counter (OTC) items, meal benefits, and Dual Eligible SNPs from coverage.
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