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Wellcare Low Premium (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Low Premium (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Low Premium (HMO) in 2026, please refer to our full plan details page.
Wellcare Low Premium (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 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Low Premium (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 Low Premium (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 Low Premium (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.00. 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 $4150.00 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 Low Premium (HMO) plan offers an Enhanced Alternative drug benefit with a yearly prescription drug deductible of $615.00. After meeting this deductible, you will pay no copay for Tier 1 preferred generics at preferred pharmacies, while standard pharmacies charge a $10.00 copay. Coinsurance rates during the initial coverage phase range from 25% for standard generics and non-preferred drugs to up to 34% for preferred brands, while Tier 5 specialty drugs feature no copay. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescription drugs. Additionally, beneficiaries who qualify for the low-income subsidy can see their Part D premium reduced to $9.70.
Additional Benefits
The Wellcare Low Premium (HMO) plan offers essential medical coverage featuring no copays for primary care visits, annual physicals, fitness benefits, and home health services. Members pay copays ranging from no copay up to $25 for specialist visits, while emergency room visits require a $150 copay. Inpatient hospital stays carry a daily copay of $375 for the first seven days, with no copay for days eight through 100. Ancillary benefits include no copay for routine dental cleanings, routine eye exams, and routine hearing exams, alongside a $200 annual maximum limit for eyewear. While diabetic supplies and over-the-counter items feature no copay, durable medical equipment and dialysis services require a 20% coinsurance. Skilled nursing facility care is also covered with no copay for the first 20 days and a $218 daily copay for days 21 through 40.
Inpatient Hospital See details
Wellcare Low Premium (HMO) covers inpatient acute hospital stays with a $375 daily copay for days 1 to 7 and no copay for days 8 to 100, and inpatient psychiatric stays with a $295 daily copay for days 1 to 7 and no copay for days 8 to 90. Both benefits require prior authorization and have no coinsurance, though some sub-services like upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Low Premium (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay for blood services up to $400 for outpatient hospital and observation stays. Additionally, ambulatory surgical center visits require a $275 copay, and outpatient substance abuse sessions carry a $25 copay.
Partial Hospitalization See details
Wellcare Low Premium (HMO) covers partial hospitalization benefits with a $175 copay and no coinsurance. A doctor referral and prior authorization are required to receive these covered services.
Ambulance and Transportation Services See details
Wellcare Low Premium (HMO) covers ground and air ambulance services with a $270 copay and no coinsurance, requiring prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered in practice.
Emergency Services See details
Wellcare Low Premium (HMO) partially covers emergency services, as worldwide emergency transportation is not covered. Covered emergency room services require a $150 copay and no coinsurance, urgent care requires a $25 copay and no coinsurance, and worldwide emergency and urgent care require a $150 copay and no coinsurance up to a $50,000 maximum limit.
Primary Care See details
Primary Care benefits are partially covered under the Wellcare Low Premium (HMO) plan, with no coverage for podiatry services or routine chiropractic care. Covered primary care physician services have no copay and no coinsurance, while other covered services like specialists, therapies, and psychiatric visits feature copays ranging from $0 to $25 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Wellcare Low Premium (HMO) with no copay or coinsurance for annual physicals, fitness benefits, and alternative therapies, though kidney disease education requires a 20% coinsurance and no copay. Sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered under the Wellcare Low Premium (HMO) plan with no coinsurance and no deductible. Routine exams, fitting evaluations, and general prescription hearing aids have no copay, while Medicare-covered exams require a $5 copay; however, OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Low Premium (HMO) covers annual routine eye exams with no copay and other eye exams with a copay ranging from $0 to $5, with no deductible or coinsurance. Eyewear, including lenses, frames, and contact lenses, is also covered with no copay or coinsurance up to a $200 annual maximum limit.
Dental Services See details
Wellcare Low Premium (HMO) partially covers dental services with no coinsurance for covered benefits, though maxillofacial prosthetics and implant services are not covered. Preventive care like cleanings and oral exams has no copay, while other covered services require copayments ranging from no copay up to $2,250.
Home Infusion bundled Services See details
Wellcare Low Premium (HMO) covers home infusion bundled services, which require prior authorization and step therapy. Medicare Part B insulin drugs require a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Wellcare Low Premium (HMO) covers dialysis services with a 20% coinsurance and no copay, though a doctor referral is required.
Medical Equipment See details
Wellcare Low Premium (HMO) covers durable medical equipment, prosthetics, and diabetic therapeutic shoes with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Wellcare Low Premium (HMO) covers diagnostic and radiological services with no copay for lab services and diagnostic tests. Outpatient x-rays have a $25 copay, diagnostic radiological services carry a copay of up to $300, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Wellcare Low Premium (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a doctor referral are required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Low Premium (HMO) plan, as none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice. Because these services are not covered, there are no copay or coinsurance benefits available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Wellcare Low Premium (HMO) with no coinsurance, but require a doctor referral and prior authorization. There is no copay for days 1 to 20 and days 41 to 100, and a $218 copay for days 21 to 40, though additional days beyond Medicare-covered SNF are not covered.
Other Services See details
Wellcare Low Premium (HMO) partially covers Other Services, offering over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and dual eligible SNPs with highly integrated services are not covered under this plan.
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