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Wellcare Specialty Simple (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Specialty Simple (HMO-POS C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Specialty Simple (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Wellcare Specialty Simple (HMO-POS C-SNP) is a HMO-POS C-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in Nevada. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Specialty Simple (HMO-POS C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Specialty Simple (HMO-POS C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Specialty Simple (HMO-POS C-SNP).
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 Specialty Simple (HMO-POS C-SNP), 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 $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:
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Drug Coverage
The Wellcare Specialty Simple (HMO-POS C-SNP) plan has a $420 deductible for prescription drugs. After the deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay no copay for preferred generic and specialty tier drugs at preferred and mail-order pharmacies. However, you will pay 25% coinsurance for standard generic drugs at both preferred and standard pharmacies.
Additional Benefits
The Wellcare Specialty Simple (HMO-POS C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have no copay for the first 90 days, while outpatient services have copays ranging from $0 to $140 depending on the service. Emergency services and primary care services have no copay, and preventive, hearing, and vision services, have no copay. Additional benefits include coverage for dental services with no copay for preventive services and 40% coinsurance for restorative services, home infusion bundled services with copays or coinsurance depending on the drug, and durable medical equipment and prosthetics with 20% coinsurance. The plan also covers ambulance and transportation services, with copays for ground and air ambulance services, and no copay for transportation to a plan-approved health-related location.
Inpatient Hospital See details
Inpatient Hospital services, including both Acute and Psychiatric, are covered with no copay for days 1-90. Additional days for Inpatient Hospital-Acute and Psychiatric, and Non-Medicare-covered stays for both, are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $50, observation services with a copay between $50 and $140, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Specialty Simple (HMO-POS C-SNP) plan. This benefit requires prior authorization and has a copay of $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $200 copay for ground and air ambulance services, and no copay for transportation services to a plan-approved health-related location. Transportation services to any health-related location are not covered. Transportation services to a plan-approved health-related location are limited to 24 one-way trips per year.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered under the Wellcare Specialty Simple (HMO-POS C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay and no coinsurance, and Urgently Needed Services have a $10 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Wellcare Specialty Simple (HMO-POS C-SNP) plan. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have no copay, while Occupational Therapy Services, Mental Health Specialty Services, Psychiatric Services, and Additional Telehealth Benefits have a copay between $0 and $25.
Preventive Services See details
Preventive Services include no copay for Medicare-covered services, annual physical exams, and other preventive services like glaucoma screenings and diabetes self-management training. Additional preventive services, such as Fitness Benefit, and Alternative Therapies have no copay.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay, and prescription hearing aids (all types) are covered with no copay, up to a maximum of $1,000 per year. OTC hearing aids, and prescription hearing aids of the inner, outer, and over the ear types are not covered.
Vision Services See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers vision services, including eye exams and eyewear. Routine eye exams and eyewear have no copay, while eyewear has a combined maximum plan benefit of $200 per year.
Dental Services See details
The Wellcare Specialty Simple (HMO-POS C-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay, but with limitations on the number of visits and periodicity, and restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with a 40% coinsurance. Orthodontic services are covered up to a maximum of $3000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Specialty Simple (HMO-POS C-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Specialty Simple (HMO-POS C-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; some services are covered, but Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment includes Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, both with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with a copay of at most $50, therapeutic radiological services with coinsurance of at most 20%, and outpatient X-ray services with a $75 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellcare Specialty Simple (HMO-POS C-SNP) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Specialty Simple (HMO-POS C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services," Wellcare Specialty Simple (HMO-POS C-SNP) covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit of $164 every three months, and Meal Benefits with no copay and a doctor referral. Acupuncture, 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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