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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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 $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) features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. If you qualify for the low-income subsidy (LIS), your Part D premium can be reduced to $0. During the initial coverage phase, Tier 1 preferred generics have no copay at preferred pharmacies and a $10.00 copay at standard pharmacies, while Tier 5 specialty drugs have no copay at either pharmacy. Other tiers require coinsurance, including 25% for standard generics and non-preferred drugs, and 39% for preferred brands. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Wellcare Specialty Simple (HMO C-SNP) plan offers robust coverage with many essential services available with no copay or coinsurance. Members enjoy no copays for primary and specialist care, preventive services, routine vision and hearing exams, home health care, and diagnostic lab tests. The plan also features valuable extras like up to 24 free one-way transportation trips per year, acupuncture, and over-the-counter benefits at no cost. For more intensive medical needs, the plan utilizes affordable copays and coinsurance to keep out-of-pocket costs predictable. Inpatient hospital stays require a $50 copay per day for the first five days and no copay for remaining days, while emergency room visits have a $150 copay. Dental care, prescription hearing aids, and eyewear are also covered, though certain specialized services, medical equipment, and dialysis require coinsurance or copays.
Inpatient Hospital See details
Wellcare Specialty Simple (HMO C-SNP) partially covers inpatient hospital acute and psychiatric services, requiring a $50 copay per day for days 1 through 5, no copay for days 6 through 90, and no coinsurance. Prior authorization and referrals are required, and certain services like upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Specialty Simple (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Other covered benefits require copays, including $0 to $150 for outpatient hospital services, $150 per stay for observation services, and $25 per session for outpatient substance abuse services.
Partial Hospitalization See details
Wellcare Specialty Simple (HMO C-SNP) covers partial hospitalization services with a $175 copay and no coinsurance. Prior authorization and a doctor referral are required to access this benefit.
Ambulance and Transportation Services See details
Wellcare Specialty Simple (HMO C-SNP) covers ground and air ambulance services with a $200 copay and no coinsurance. Transportation services are partially covered under the plan, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Specialty Simple (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Specialty Simple (HMO C-SNP) covers primary care, specialist visits, therapies, podiatry, and chiropractic care with no copay and no coinsurance. Mental health, psychiatric, and telehealth services are also covered, with copays ranging from no copay up to $25 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Wellcare Specialty Simple (HMO C-SNP) with no copay and no coinsurance for covered benefits like annual physical exams, fitness benefits, and glaucoma screenings. Several sub-services are not covered under this plan, including health education, weight management programs, in-home safety assessments, therapeutic massage, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by Wellcare Specialty Simple (HMO C-SNP), featuring no copay or coinsurance for annual routine exams, fittings, and prescription hearing aids up to a $500 annual limit per ear. However, OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Specialty Simple (HMO C-SNP) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam per year and eyewear up to a $100 annual limit. Prior authorization is required for these benefits, which cover eye exams, contacts, lenses, frames, and upgrades.
Dental Services See details
Wellcare Specialty Simple (HMO C-SNP) partially covers dental services with no coinsurance and copays ranging from no copay up to $2,250, depending on the service. Most preventive and comprehensive dental procedures are covered, though maxillofacial prosthetics and implant services are not covered.
Home Infusion bundled Services See details
Wellcare Specialty Simple (HMO C-SNP) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other Medicare Part B chemotherapy, radiation, and miscellaneous drugs require no copay and carry a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Wellcare Specialty Simple (HMO C-SNP) covers dialysis services with a 20% coinsurance and no copay. A doctor referral is required to receive these covered services.
Medical Equipment See details
Medical Equipment benefits are covered by Wellcare Specialty Simple (HMO C-SNP) with prior authorization required. Durable medical equipment, prosthetics, and medical supplies carry a 20% coinsurance and no copay, while diabetic supplies and therapeutic shoes or inserts are offered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellcare Specialty Simple (HMO C-SNP) covers diagnostic and radiological services, requiring prior authorization and a doctor referral. Members pay no copay or coinsurance for diagnostic procedures, lab services, and outpatient X-rays, while diagnostic radiological services have a copay of up to $50 and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Wellcare Specialty Simple (HMO C-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Cardiac Rehabilitation Services See details
Wellcare Specialty Simple (HMO C-SNP) does not cover Cardiac Rehabilitation Services, as all associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Specialty Simple (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and 41 to 100, and a $218 copay for days 21 to 40. Prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Specialty Simple (HMO C-SNP) offers partially covered Other Services, featuring acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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