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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 Nevada. 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 $4000.00 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 (HMO-POS) 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 preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options for these lower-tier drugs require a small copay, ranging from $5 to $30 depending on the supply. Higher-tier medications, including Tier 3 preferred brands and Tier 5 specialty drugs, carry a 25% coinsurance, while Tier 4 non-preferred drugs require a 34% coinsurance across all pharmacy types. Additionally, Tier 6 select care drugs are highly affordable with no copay required at any standard or preferred pharmacy. This structure helps beneficiaries manage their healthcare costs effectively by choosing preferred network pharmacies for their medication needs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers robust medical coverage with no copay for primary care visits, preventive care services, and home health care. Specialist office visits require a $25 copay, while inpatient hospital stays have a daily copay of $375 for days 1 through 6 and no copay for days 7 through 90. Emergency room visits have a $150 copay and urgently needed care has a $30 copay, both with no coinsurance. Routine dental, vision, and hearing exams are available with no copay, alongside a $200 annual allowance for eyewear and up to $500 per ear for hearing aids. Skilled nursing facility care features no copay for days 1 to 20 and days 41 to 100, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Standard diagnostic tests and lab services are also covered with no copay and no coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient hospital services with no coinsurance, though prior authorization is required. Patients pay a daily copay of $375 for days 1 through 6 of an acute stay and $325 for days 1 through 6 of a psychiatric stay, with no copay for days 7 through 90. This benefit is partially covered, as upgrades, additional days, 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 $280 copay for outpatient hospital services and a $150 to $280 copay per stay for observation services. Ambulatory surgical center services require a $200 copay, outpatient substance abuse sessions have a $25 copay, and outpatient blood services are covered with no copay or deductible.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $250 copay and no coinsurance per trip. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, though 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 urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 lifetime maximum with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) features primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Physical, occupational, and speech therapies require a $35 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) covers preventive services, including annual physical exams, fitness benefits, alternative therapies, and select screenings, with no copay and no coinsurance. Kidney disease education is available with no copay and a 20% coinsurance, though several supplemental services like health education, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Simple (HMO-POS) covers Medicare-covered hearing exams with a $25 copay and no coinsurance, while annual routine exams and fitting evaluations have no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) vision services are partially covered, offering one routine eye exam annually and eyewear up to a $200 yearly limit with no copay and no coinsurance. While contact lenses, eyeglasses, and upgrades are covered with no copay or coinsurance, other eye exam services are not covered, and prior authorization is required.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), as maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental services require a $25 copay and no coinsurance, preventive care is available with no copay and no coinsurance, and covered comprehensive dental services have no copay and a 40% coinsurance up to a $3,000 annual limit.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization is required and step therapy may apply. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have 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 or inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Wellcare Simple (HMO-POS) with no copay and no coinsurance for diagnostic tests, lab services, and diagnostic radiology. Outpatient X-rays require a $50 copay, therapeutic radiological services require a 20% coinsurance, and prior authorization is required.
Home Health Services See details
Wellcare Simple (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the Wellcare Simple (HMO-POS) plan; however, some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance, featuring no copay for days 1 to 20 and days 41 to 100, and a $218 daily copay for days 21 to 40. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, providing acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Acupuncture is limited to 12 treatments per year and requires prior authorization, and OTC items are available via reimbursement.
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