A non-government entity
Wellcare Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in NV. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Simple (HMO-POS) 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-POS).
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-POS), 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 $1000.00 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:
Sign up for Wellcare Simple (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple (HMO-POS) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacy options for these tiers require a low copay, starting at $5 for Tier 1 and $10 for Tier 2 for a one-month supply. For higher-tier medications, Tier 3 preferred brands and Tier 5 specialty drugs carry a 25% coinsurance, while Tier 4 non-preferred drugs require a 33% to 34% coinsurance. Notably, Tier 6 select care drugs are fully covered with no copay regardless of whether you use a preferred or standard pharmacy or mail-order service.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers robust medical coverage, featuring no copayments and no coinsurance for inpatient hospital stays up to 90 days, primary care visits, specialist consultations, and physical therapies. Outpatient hospital services require no coinsurance and a copay of up to $50, while emergency care has a $150 copay that is waived upon hospital admission. Additionally, skilled nursing facility stays are covered with no copay for days 1 to 20 and days 31 to 100. For supplemental care, the plan provides generous dental, vision, and hearing benefits with no copayments or coinsurance, including up to $3,000 annually for dental care and $1,000 per ear for prescription hearing aids. Home health services are covered with no copay, while durable medical equipment and dialysis services require no copay and a 20% coinsurance. Members also benefit from no-copay preventive care, routine eye exams with a $200 eyewear allowance, and up to 24 one-way transportation trips per year with no copay.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers Medicare-approved inpatient acute and psychiatric hospital stays with no copay and no coinsurance for days 1 through 90, though prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $50 copay for outpatient hospital services and a $50 to $150 copay per stay for observation services. Additionally, ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $10 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Simple (HMO-POS) plan with a $175.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Wellcare Simple (HMO-POS) plan, with prior authorization required for both. Medicare-covered ground and air ambulance services require a $200 copay and no coinsurance, while plan-approved transportation is partially covered with no copay or coinsurance for up to 24 one-way trips per year (transportation to any health-related location is not covered).
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $10 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 benefit limit with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) primary care, specialist visits, and physical, occupational, and speech therapies are covered with no copay and no coinsurance. Mental health and psychiatric sessions require a $10 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) covers preventive services with no copay and no coinsurance for annual physicals, fitness benefits, remote access technologies, alternative therapies, and standard screenings. Kidney disease education has no copay and a 20% coinsurance, but additional preventive services are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy-related wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Simple (HMO-POS) covers routine hearing exams, fitting evaluations, and prescription hearing aids with no copay, no coinsurance, and no deductible, providing up to $1,000 per ear annually. However, this benefit is partially covered because OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, though prior authorization is required. The plan covers one routine eye exam per year and provides a $200 annual maximum allowance for eyewear, including contact lenses and eyeglasses, while other eye exam services are not covered.
Dental Services See details
Wellcare Simple (HMO-POS) provides partially covered dental services with no copay and no coinsurance for covered benefits, though prior authorization is required. While many preventive and comprehensive dental services are covered up to a $3,000 annual limit, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO-POS) with prior authorization required. Members pay no copay and no coinsurance for diagnostic tests, lab work, and diagnostic radiology, while outpatient X-rays require a $50 copay with coinsurance and therapeutic radiology carries a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) features no coinsurance for cardiac rehabilitation services, but in practice, some services are covered while specific sub-services—including cardiac rehabilitation ($50 copay), intensive cardiac rehabilitation ($65 copay), pulmonary rehabilitation ($40 copay), and SET for PAD rehabilitation ($30 copay)—are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 31 to 100, a $218 daily copay for days 21 to 30, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) provides coverage for other services with no copays and no coinsurance, including up to 12 acupuncture treatments per year, over-the-counter items, and meals for chronic illnesses. This benefit is partially covered, as other miscellaneous services and Dual Eligible SNPs with Highly Integrated Services are not covered under the plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved