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Wellcare Premium Ultra (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Premium Ultra (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Premium Ultra (HMO) in 2025, please refer to our full plan details page.
Wellcare Premium Ultra (HMO) is a HMO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in CA. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Premium Ultra (HMO) 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 Premium Ultra (HMO).
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 Premium Ultra (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $144.00. 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 $9350.00 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 Premium Ultra (HMO) plan has a $420 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and mail order, while standard generic drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your monthly Part D premium may be reduced to $3.70. This plan offers an enhanced alternative drug benefit.
Additional Benefits
The Wellcare Premium Ultra (HMO) plan offers a range of benefits, including inpatient hospital stays with copays, outpatient services with varying copays, and coverage for partial hospitalization. Emergency and urgent care services have copays, while ambulance services have a $300 copay. Primary care and specialist visits have copays, and preventive services, such as annual physical exams, are covered. Additional benefits include hearing, vision, and dental services with varying copays and maximum benefits. The plan also covers home infusion, dialysis, and medical equipment with coinsurance. Diagnostic and radiological services have copays and coinsurance, and home health services have no copay. Skilled Nursing Facility (SNF) services have no copay for some days, with a copay for others.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor's referral. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-7, and no copay for days 8-90, and you get 10 additional days with no copay; Inpatient Hospital Psychiatric has a $290 copay for days 1-7 and no copay for days 8-90. 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, including all outpatient hospital services, observation services, and outpatient substance abuse services are covered, with copays ranging from $0 to $375. Ambulatory Surgical Center (ASC) Services have a $325 copay, and Outpatient Blood Services are covered with no copay. Individual and group sessions for outpatient substance abuse have a copay of $25.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Premium Ultra (HMO) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Premium Ultra (HMO) plan. Medicare-covered ground and air ambulance services have a $300 copay, with no coinsurance, while transportation services to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency Services under the Wellcare Premium Ultra (HMO) plan include a $110 copay with no coinsurance. Urgent care services have a $25 copay with no coinsurance. Worldwide emergency coverage has a $110 copay, while worldwide urgent coverage also has a $110 copay; worldwide emergency transportation is not covered.
Primary Care See details
The Wellcare Premium Ultra (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $15 copay, physician specialist services with a $15 copay, mental health specialty services with a $25 copay for individual and group sessions, podiatry services with a $15 copay, other health care professional services with a copay between $0 and $15, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with a $15 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered. Annual physical exams have no copay, while Kidney Disease Education Services have 20% coinsurance, and Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing services include hearing exams with a $15 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a $500 maximum benefit per year. Prescription hearing aids (all types) have no copay. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$15, while routine eye exams have no copay. Eyewear has no copay and a combined maximum benefit of $100 per year.
Dental Services See details
Dental services are covered, including Medicare dental services with a $15 copay. Other dental services include oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with a $15 copay, prophylaxis (cleaning) with no copay, fluoride treatment with no copay, other preventive dental services with a copay between $0 and $55, and restorative services with a copay between $0 and $300. Adjunctive general services have a copay between $0 and $125, endodontics have a copay between $5 and $275, periodontics have a copay between $0 and $375, prosthodontics (removable) have a copay between $70 and $250, prosthodontics (fixed) have a copay between $0 and $225, oral and maxillofacial surgery have a copay between $0 and $70, and orthodontics have a copay between $0 and $2250. Maxillofacial prosthetics and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Premium Ultra (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Premium Ultra (HMO) plan, with a doctor referral required. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance for Medicare-covered services. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Premium Ultra (HMO) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $375, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $100 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Premium Ultra (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Premium Ultra (HMO) plan. A doctor's referral is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, requiring prior authorization and a doctor's referral. You will have no copay for days 1-20 and days 71-100, and a $214 copay for days 21-70; there is no coinsurance.
Other Services See details
Other Services are not covered by the Wellcare Premium Ultra (HMO) plan. Specifically, acupuncture, over-the-counter items, meal benefits, 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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