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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 2025, 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 out of 5 stars in 2025.
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 $88.70. 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 $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 $4400.00 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 has a $420 deductible for prescription drugs. After the deductible is met, you'll pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, there is no copay at preferred pharmacies and preferred mail order, and a $10 copay at standard pharmacies and standard mail order. For specialty drugs, there is no copay at any pharmacy. For other drugs, you will pay coinsurance, which is a percentage of the drug's cost.
Additional Benefits
The Wellcare Giveback (HMO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have copays, while outpatient services involve copays and coinsurance. The plan also includes coverage for ambulance, emergency, and vision services with copays, in addition to no copay for primary care visits, home health services, and preventive services. The plan also covers hearing exams, dental services, home infusion, and dialysis services with copays or coinsurance. Medical equipment and diagnostic services are covered with coinsurance or copays, and skilled nursing facilities have copays for certain days. However, some services like cardiac rehabilitation and other services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $395 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you'll pay a $325 copay for days 1-7, and no copay for days 8-90. Additional days, non-Medicare-covered stays, and upgrades are not covered for either service.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 20% coinsurance and a copay between $0 and $250, Observation Services with a 20% coinsurance and a $125 copay, Ambulatory Surgical Center (ASC) Services with a $200 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 Giveback (HMO) plan with a $105 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Giveback (HMO) plan. All Ambulance Services require prior authorization and have a $295 copay for both ground and air ambulance services, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
The Wellcare Giveback (HMO) plan covers emergency services with a $125 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance; in addition, the plan covers worldwide emergency coverage with a $125 copay and no coinsurance, and worldwide urgent coverage with a $125 copay and no coinsurance, but does not cover worldwide emergency transportation.
Primary Care See details
The Wellcare Giveback (HMO) plan covers primary care physician services with no copay and chiropractic services with a $20 copay. Occupational therapy services have a $40 copay, and physician specialist services have a $40 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, and opioid treatment program services have a copay that varies from $25 to $40. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a copay from $0 to $40.
Preventive Services See details
The Wellcare Giveback (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay. Kidney Disease Education Services have a 20% coinsurance. Some services, like Health Education and Therapeutic Massage, are not covered.
Hearing Services See details
Hearing exams are covered by the Wellcare Giveback (HMO) plan, with a $40 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but the plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
The Wellcare Giveback (HMO) plan covers vision services, including eye exams with a copay between $0 and $40, and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $100 per year. Routine eye exams have no copay and are covered once per year.
Dental Services See details
The Wellcare Giveback (HMO) plan covers Medicare Dental Services with a $40 copay, and covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Orthodontic, restorative, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, and oral surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Giveback (HMO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the Wellcare Giveback (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment are covered. Durable medical equipment has a 20% coinsurance and requires authorization, while durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a 20% coinsurance. Diabetic supplies have no copay, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $40, lab services with no copay, and outpatient X-ray services with a $25 copay. Therapeutic Radiological Services have a coinsurance of at least 20%, and Diagnostic Radiological Services have a copay of at most $250.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Giveback (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Giveback (HMO) plan. There is no copay for days 1-20 and days 51-100, but a $214 copay applies for days 21-50.
Other Services See details
Other Services, including acupuncture, over-the-counter items, meal benefits, and other services are not covered. Additionally, 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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