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Wellcare Simple Ruby (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Ruby (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple Ruby (HMO) in 2025, please refer to our full plan details page.
Wellcare Simple Ruby (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 Simple Ruby (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 Simple Ruby (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 Simple Ruby (HMO), 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 $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 Simple Ruby (HMO) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay the following costs for drugs in each tier. For preferred generic drugs, there is no copay at preferred pharmacies and preferred mail order, and a $10 copay at standard pharmacies and standard mail order. Standard generic drugs have a 25% coinsurance, preferred brand drugs have a 44% coinsurance, and non-preferred drugs have a 28% coinsurance. Specialty tier drugs have no copay. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Wellcare Simple Ruby (HMO) plan offers comprehensive coverage with a variety of benefits. This plan covers inpatient hospital stays with a copay, outpatient services with varying copays and coinsurance, and includes coverage for emergency services with a copay. The plan also covers primary care, preventive, vision, hearing, and dental services with no copays for many services. Additionally, the plan covers home infusion, dialysis, medical equipment, diagnostic and radiological services, and home health services.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a $425 copay for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital-acute have no copay for days 91-100, and the plan covers 10 additional days per benefit period. Non-Medicare-covered stays and upgrades for inpatient hospital-acute and additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a 15% coinsurance and a copay between $0 and $300, while Observation Services have a 15% coinsurance and a $140 copay. Ambulatory Surgical Center Services have a $300 copay, and Outpatient Substance Abuse Services have a $25 copay for both individual and group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple Ruby (HMO) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellcare Simple Ruby (HMO) plan. Ground and Air Ambulance Services have a $300 copay, and there is no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Simple Ruby (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services has a $25 copay; all services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Ruby (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professionals, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, and physician specialist services have no copay. Individual and group mental health and psychiatric sessions have a $25 copay, and additional telehealth benefits have a copay between $0 and $25.
Preventive Services See details
The Wellcare Simple Ruby (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Alternative Therapies, and Remote Access Technologies, all with no copay. However, the plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and several other services. Kidney Disease Education Services have 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
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids (all types) are covered with a maximum benefit of $500 per year, per ear, with no copay, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered with no copay, and eyewear has a combined maximum plan benefit of $100 per year. Routine eye exams are limited to one per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery, and orthodontics. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments have no copay, while other diagnostic dental services have a $15 copay, other preventive dental services have a copay between $0 and $55, restorative services have 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 has 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 Simple Ruby (HMO) plan. Medicare Part B Insulin Drugs have 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 under the Wellcare Simple Ruby (HMO) plan with a doctor referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Simple Ruby (HMO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside of the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Wellcare Simple Ruby (HMO) plan covers diagnostic and radiological services, including diagnostic procedures, lab services, and radiological services. Diagnostic procedures and lab services have no copay, while radiological services have a copay of up to $300 and coinsurance of up to 20% for therapeutic services, and a $50 copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple Ruby (HMO) 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 not covered by the Wellcare Simple Ruby (HMO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Ruby (HMO) plan with prior authorization and a doctor's referral. For days 1-20, there is no copay, for days 21-40, there is a $214 copay, and for days 41-100, there is no copay.
Other Services See details
Other Services includes acupuncture and over-the-counter (OTC) items. Acupuncture has no copay, and requires prior authorization and a doctor referral, with a limit of 12 treatments per year. OTC items also have no copay, with a maximum benefit coverage amount of $30 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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