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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 $6750.00 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 preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, and a $10 copay at standard pharmacies and standard mail order. Specialty tier drugs have no copay.
Additional Benefits
The Wellcare Premium Ultra (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $375. Emergency services have a $125 copay, while primary care visits and many preventive services have no copay. Additional benefits include coverage for hearing, vision, and dental services, with copays and coinsurance applicable to some services. Home health services, diagnostic and radiological services, and skilled nursing facility services are covered, with some requiring copays or coinsurance. However, certain services like cardiac rehabilitation and others are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $380 copay for days 1-6 and no copay for days 7-90, and for Inpatient Hospital Psychiatric services, you will pay a $375 copay for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute have no copay for days 91-100, and Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered under the Wellcare Premium Ultra (HMO) plan. Outpatient hospital services have a copay ranging from $0 to $375, observation services have a copay of $125 to $375, ambulatory surgical center services have a $300 copay, and outpatient blood services have 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 with a $105 copay, but requires prior authorization and a doctor's referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Premium Ultra (HMO) plan. Ground and Air Ambulance Services have a $300 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
The Wellcare Premium Ultra (HMO) plan covers emergency services with a $125 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency coverage and worldwide urgent coverage each have a $125 copay, while worldwide emergency transportation is not covered; there is a maximum benefit of $50,000 for worldwide services.
Primary Care See details
The Wellcare Premium Ultra (HMO) plan covers primary care physician services with no copay, chiropractic services with a $10 copay, occupational therapy with a $10 copay, and physician specialist services with a $10 copay. Mental health specialty services and psychiatric services have a $25 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $10 copay. Additional telehealth benefits have a copay between $0 and $25, and opioid treatment program services have a $10 copay. Podiatry services are not covered.
Preventive Services See details
The Wellcare Premium Ultra (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Remote Access Technologies, and Alternative Therapies, all with no copay. Kidney Disease Education Services are covered with a 20% coinsurance. Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
The Wellcare Premium Ultra (HMO) plan covers hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per ear, and prescription hearing aids (all types) have no copay, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Wellcare Premium Ultra (HMO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay of $0-$10, and routine eye exams have no copay. Eyewear is covered with no copay and a combined maximum benefit of $300 per year, and also includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with no copay.
Dental Services See details
The Wellcare Premium Ultra (HMO) plan covers dental services, including Medicare Dental Services with a $10 copay, oral exams and dental x-rays with no copay, and other diagnostic, preventive, restorative, and orthodontic services with varying copays ranging from $0 to $2250; however, maxillofacial prosthetics and implant services are not covered. Oral exams are limited to 2 visits per year, while dental x-rays and fluoride treatments are limited to 1 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, the copay is $35. 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 under the Wellcare Premium Ultra (HMO) plan, but a referral from your doctor is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellcare Premium Ultra (HMO) plan. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Premium Ultra (HMO) plan. Services such as Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Premium Ultra (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20 and days 61-100, and a $214 copay for days 21-60.
Other Services See details
Other Services are not covered by the Wellcare Premium Ultra (HMO) plan, including 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, case management, and more. No authorization or referrals are required for any services.
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