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Wellcare Simple Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple Value (HMO) in 2025, please refer to our full plan details page.
Wellcare Simple Value (HMO) is a HMO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in Arizona. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Simple Value (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 Value (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 Value (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 $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 $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 Value (HMO) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay the following costs for your prescriptions. For preferred generic drugs, you'll have no copay at preferred pharmacies and preferred mail order, and a $10 copay at standard pharmacies and standard mail order. For standard generic drugs, you will pay 25% coinsurance. For preferred brand drugs, you will pay 43% coinsurance. For non-preferred drugs, you will pay 28% coinsurance. For specialty tier drugs, there is no copay. Once your total drug costs reach $2000, you will enter the next coverage phase.
Additional Benefits
The Wellcare Simple Value (HMO) plan offers a range of benefits with varying costs. Hospital stays have a copay that varies by the length of stay, and outpatient services have copays depending on the type of service. Emergency services, primary care, preventive services, hearing, vision, and dental services often have no copay, but some services like ambulance and partial hospitalization have a copay. The plan also covers home health services, skilled nursing facilities, and medical equipment with varying cost-sharing. Additionally, there are benefits for home infusion, dialysis, and diagnostic services. Other services like acupuncture and over-the-counter items are included with no copay.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $175 for days 1-6, and no copay for days 7-90, and additional days for Inpatient Hospital-Acute are covered with no copay for days 91-100. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Wellcare Simple Value (HMO) plan. Outpatient Hospital Services have a copay between $0 and $275, Observation Services have a copay between $140 and $275, and Ambulatory Surgical Center (ASC) Services have a $200 copay. Outpatient Substance Abuse Services and Outpatient Blood Services are also covered, with Individual and Group Sessions for Outpatient Substance Abuse having a $25 copay, and Outpatient Blood Services having no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple Value (HMO) plan, but requires prior authorization. You will pay a $130 copay for this benefit.
Ambulance and Transportation Services See details
The Wellcare Simple Value (HMO) plan covers ambulance and transportation services with prior authorization. Ground and air ambulance services have a $350 copay, while transportation services to a plan-approved health-related location have no copay and cover up to 12 one-way trips per year via rideshare, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $140, $20, and $140 respectively, with no coinsurance. Worldwide Emergency Transportation is not covered. Worldwide Urgent Coverage has a copay of $140 with no coinsurance.
Primary Care See details
The Wellcare Simple Value (HMO) plan covers primary care physician services with a copay between $0 and $50, chiropractic services with no copay, occupational therapy services with no copay, physician specialist services with no copay, mental health and psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with no copay, additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with no copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by the Wellcare Simple Value (HMO) plan. You have no copay for your annual physical exam, and no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a maximum plan benefit coverage of $750 per ear per year, with no copay for all types of prescription hearing aids except for inner ear, outer ear, and over the ear aids, which are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams, eyewear, and contact lenses. Eye exams and eyewear have no copay, and eyewear has a combined maximum plan benefit of $200 per year.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery, all with no copay. Orthodontic services are covered up to a maximum of $1,500 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 by the Wellcare Simple Value (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 by the Wellcare Simple Value (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance, while Prosthetics, and Medical Supplies also 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, with a copay for diagnostic procedures/tests that ranges from $0 to $30, and a $0 copay for lab services. Diagnostic Radiological Services have a copay of at most $275, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a copay of $75.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple Value (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Simple Value (HMO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20 and 41-100, there is no copay, but for days 21-40, the copay is $214.
Other Services See details
Other Services include acupuncture and over-the-counter (OTC) items, with no copay for either. Acupuncture is limited to 24 treatments per year and requires prior authorization, while OTC items have a maximum benefit coverage amount of $65.00 every three months. Meal Benefit, 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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