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Wellcare Specialty Simple (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Specialty Simple (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Specialty Simple (HMO C-SNP) in 2025, please refer to our full plan details page.
Wellcare Specialty Simple (HMO C-SNP) is a HMO C-SNP 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 Specialty Simple (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Specialty Simple (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Specialty Simple (HMO C-SNP).
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 Specialty Simple (HMO C-SNP), 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 $300.00 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 $2400.00 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 Specialty Simple (HMO C-SNP) plan has a $300 deductible for prescription drugs. After the deductible, you will pay the following costs. For preferred generic drugs and specialty tier drugs, there is no copay at any pharmacy. For standard generic drugs, you pay 25% coinsurance. For preferred brand drugs, you pay 41% coinsurance, and for non-preferred drugs, you pay 29% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Specialty Simple (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $50 copay for days 1-5, with no copay for days 6-90. Outpatient services have copays ranging from $0 to $150, and emergency services have a $140 copay. This plan includes no copay for primary care, preventive services, hearing exams, vision exams, and many dental services. Additionally, the plan covers home health services, and many other services, with no copay. However, this plan does not cover some services such as Cardiac Rehabilitation Services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-5, there is a $50 copay, and for days 6-90, there is no copay. Additional days for inpatient hospital-acute have no copay for days 91-100. Non-Medicare-covered stays and upgrades for inpatient hospital are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $150, and observation services, with a copay between $140 and $150. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services include individual and group sessions with a $25 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Specialty Simple (HMO C-SNP) 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 include coverage for ground and air ambulance services, each with a $200 copay, and transportation services to plan-approved health-related locations with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage, have a $140 copay, while Urgently Needed Services have no copay; all services have no coinsurance. Worldwide Emergency Transportation is not covered, and Worldwide Emergency Services have a maximum plan benefit coverage of $50,000.
Primary Care See details
The Wellcare Specialty Simple (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and telehealth benefits have no copay, while mental health specialty services and psychiatric services have a $25 copay for individual and group sessions, and there is a $0-$25 copay for additional telehealth benefits.
Preventive Services See details
The Wellcare Specialty Simple (HMO C-SNP) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, including Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a maximum plan benefit of $500 per year, and prescription hearing aids (all types) are covered with no copay, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. There is no copay for eye exams, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, or upgrades. Eyewear has a combined maximum plan benefit coverage of $100 per year.
Dental Services See details
Dental services are covered, including oral exams and dental x-rays with no copay, and other diagnostic dental services with a $15 copay. Prophylaxis (cleaning), and fluoride treatments have no copay, and other preventative dental services have a copay between $0 and $55. Orthodontic Services are covered with copays ranging from $0 to $2250, and other services such as restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, fixed and removable, and oral and maxillofacial surgery have copays ranging from $0 to $375. Maxillofacial prosthetics and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 Specialty Simple (HMO C-SNP) plan, and a doctor referral is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, 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 the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, and radiological services. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of up to $50, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Specialty Simple (HMO C-SNP) 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 under the Wellcare Specialty Simple (HMO C-SNP) plan. Although the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, none of these services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Specialty Simple (HMO C-SNP) plan, but require prior authorization and a doctor's referral. For days 1-20 and 51-100, there is no copay, while days 21-50 have a copay of $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Specialty Simple (HMO C-SNP) plan covers acupuncture with no copay, and over-the-counter (OTC) items with no copay, up to $72 every three months, as well as a meal benefit with no copay, all of which may require a doctor referral. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other additional services.
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