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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 2025, 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 out of 5 stars in 2025.
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 $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 $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) plan has a $420 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs 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 pay 25% coinsurance, and for preferred brand drugs, you pay 43% coinsurance. For non-preferred drugs, you pay 28% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services range from no copay to a $280 copay depending on the service. Emergency services have a $140 copay, and primary care visits, along with many preventive services, have no copay. This plan includes coverage for hearing, vision, and dental services, each with specific copays or coinsurance. The plan also covers home health services and skilled nursing facilities. Additional benefits include coverage for ambulance services, and transportation, with copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Wellcare Simple (HMO-POS) plan, with a copay of $375 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $325 for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the Wellcare Simple (HMO-POS) plan, including outpatient hospital services with a copay between $0 and $280, observation services with a copay between $140 and $280, and ambulatory surgical center (ASC) services with a $200 copay. Outpatient substance abuse services have a $25 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple (HMO-POS) plan, including ground and air ambulance services, which each have a $250 copay. Transportation Services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the Wellcare Simple (HMO-POS) plan, with a $140 copay for emergency services and worldwide emergency coverage, and a $30 copay for urgently needed services. Worldwide emergency transportation is not covered, and the maximum plan benefit coverage for worldwide emergency services is $50,000.
Primary Care See details
The Wellcare Simple (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $35 copay, and physician specialist services with a $25 copay. This plan also covers mental health specialty services, psychiatric services, and opioid treatment program services with a copay of $25 for individual and group sessions, and covers physical therapy and speech-language pathology services with a $35 copay. Additional telehealth benefits are covered with a copay between $0 and $35. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Wellcare Simple (HMO-POS) plan covers preventive services including an annual physical exam with no copay, and other preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Kidney disease education services have a 20% coinsurance. Additional preventive services, including health education, in-home safety assessment, and others, are not covered.
Hearing Services See details
The Wellcare Simple (HMO-POS) plan covers hearing exams with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per year, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Wellcare Simple (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$25, and eyewear with no copay. Routine eye exams have no copay and are limited to one per year, while eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The Wellcare Simple (HMO-POS) plan covers dental services including oral exams, dental x-rays, and other diagnostic services with no copay, and covers preventative services like cleanings, fluoride treatment, and other preventive services with no copay. Restorative, adjunctive, endodontics, periodontics, prosthodontics, and oral surgery services are covered with a 40% coinsurance, and orthodontics is covered up to $3,000 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is 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 (HMO-POS) plan. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with a 20% coinsurance for Medicare-covered supplies, and no copay for Diabetic Supplies. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellcare Simple (HMO-POS) plan, with a copay for Medicare-covered Diagnostic Procedures/Tests and Therapeutic Radiological Services, and coinsurance for Medicare-covered X-Ray Services. Lab Services have no copay, Diagnostic Radiological Services have a copay up to $280, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (HMO-POS) 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 covered by the Wellcare Simple (HMO-POS) plan, but the specific services are not covered. The plan does not list any copays or coinsurance for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Simple (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, while days 21-30 have a $214 copay, and days 31-100 have no copay. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture and over-the-counter (OTC) items. Acupuncture has no copay and is limited to 12 treatments per year, and OTC items also have no copay with a maximum benefit coverage amount of $45 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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