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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Specialty Simple (HMO-POS C-SNP) is a HMO-POS C-SNP plan offered by Health Net of Arizona, Inc. available for the 2026 plan year to people living in Select counties in Nevada. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $1000.00 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 Specialty Simple (HMO-POS C-SNP)
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Drug Coverage
The Wellcare Specialty Simple (HMO-POS C-SNP) plan features an annual drug deductible of $615. You can benefit from no copay on Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options are also available for these tiers with copays ranging from $5 to $30. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs both require a 25% coinsurance payment. Tier 4 non-preferred drugs carry a 34% coinsurance at preferred pharmacies and a 35% coinsurance at standard pharmacies.
Additional Benefits
The Wellcare Specialty Simple (HMO-POS C-SNP) plan offers comprehensive coverage with no copays or coinsurance for inpatient hospital stays, primary care visits, specialist consultations, and preventive care. Outpatient hospital services feature low costs ranging from no copay to $50, while emergency room visits carry a $150 copay. Additionally, home health services and diagnostic lab tests are covered with no copay. For extra wellness needs, the plan provides routine dental, vision, and hearing services with no copays for preventive care, alongside annual allowances for eyewear and hearing aids. Durable medical equipment is covered with a 20% coinsurance, and diabetic supplies feature no copay. Members also receive convenient extras at no cost, including over-the-counter items and up to 24 one-way transportation trips per year.
Inpatient Hospital See details
Inpatient hospital care is partially covered by the Wellcare Specialty Simple (HMO-POS C-SNP) plan, featuring no copay and no coinsurance for Medicare-covered acute and psychiatric stays of 1 to 90 days, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers outpatient services with no coinsurance, featuring outpatient hospital copays ranging from no copay to $50, and observation services with a $50 to $150 copay per stay. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse services carry a $25 copay and no coinsurance.
Partial Hospitalization See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers Medicare-approved ground and air ambulance services with a $200 copay and no coinsurance. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Wellcare Specialty Simple (HMO-POS C-SNP) with a $150 copay and no coinsurance, while urgently needed services require a $10 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers primary care, specialist visits, podiatry, and physical, occupational, and speech therapies with no copay and no coinsurance, though chiropractic services are not covered. Mental health and psychiatric sessions require a $25 copay with no coinsurance, while additional telehealth services range from no copay to a $25 copay with no coinsurance.
Preventive Services See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers preventive services, such as annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, though sub-services like health education, in-home safety assessments, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance, subject to prior authorization. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear every year, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Wellcare Specialty Simple (HMO-POS C-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. Covered benefits require prior authorization and include one routine eye exam per year alongside a $200 annual combined limit for eyewear, including contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Wellcare Specialty Simple (HMO-POS C-SNP), offering preventive services with no copay and no coinsurance, and comprehensive services with no copay and a 40% coinsurance up to a $3,000 annual maximum. Implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Specialty Simple (HMO-POS C-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies, therapeutic shoes, and inserts are also covered with no copay and no coinsurance, though prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers diagnostic services and lab tests with no copay and no coinsurance, though prior authorization is required. Diagnostic radiological services feature a $0 minimum copay, while outpatient X-rays require a $50 copay plus coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Wellcare Specialty Simple (HMO-POS C-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Wellcare Specialty Simple (HMO-POS C-SNP) with no coinsurance, though copays are required for specific treatments. Members will pay a $50 copay for standard cardiac rehabilitation, $65 for intensive cardiac rehabilitation, $40 for pulmonary rehabilitation, and $30 for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Wellcare Specialty Simple (HMO-POS C-SNP) with no coinsurance, requiring no copay for days 1 to 20 and days 31 to 100, and a $218 copay for days 21 to 30. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Specialty Simple (HMO-POS C-SNP) partially covers other services, providing over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and other additional services are not covered, and the meal benefit requires a referral.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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