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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 $33.00. 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 $9250.00 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 features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, you pay no copay for Tier 1 preferred generics at preferred pharmacies, while standard pharmacies charge a $10.00 copay. Tier 2 standard generics and Tier 4 non-preferred drugs carry a 25% coinsurance, Tier 3 preferred brands have a 35% coinsurance, and Tier 5 specialty tier drugs require no copay. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D prescription drugs. For individuals who qualify for the full low-income subsidy, also known as Extra Help, Part D drug costs are reduced to a $0.00 copay.
Additional Benefits
The Wellcare Low Premium (HMO) plan offers affordable medical coverage with no copay or coinsurance for primary care, specialist, and telehealth visits, as well as home health services. Inpatient hospital stays require daily copays for the first five days with no copay for later days, while emergency room visits carry a $115 copay. Outpatient and diagnostic services are highly accessible, featuring no coinsurance and copays starting at no copay. Supplemental benefits include routine dental cleanings, vision exams, and annual hearing tests with no copay or coinsurance. Members also benefit from prescription hearing aid coverage up to $500 per ear and up to 12 one-way transportation trips to approved locations with no copay. Durable medical equipment and dialysis services are available with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Wellcare Low Premium (HMO) with no coinsurance. Acute care requires a $405 daily copay for days 1 to 5 and no copay for days 6 to 100, while psychiatric care requires a $400 daily copay for days 1 to 5 and no copay for days 6 to 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Low Premium (HMO) with no coinsurance, featuring copays ranging from no copay up to $250 for outpatient hospital services and $115 to $250 for observation services. Additionally, there is a $200 copay for ambulatory surgical center services, a $25 copay for outpatient substance abuse sessions, and no copay for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Wellcare Low Premium (HMO) with a $105.00 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Ambulance and Transportation Services See details
Wellcare Low Premium (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Wellcare Low Premium (HMO) partially covers emergency services, requiring a $115 copay and no coinsurance for emergency care and a $25 copay with no coinsurance for urgent care. Worldwide emergency and urgent coverage are available with a $115 copay and no coinsurance up to a $50,000 maximum, but worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are covered by Wellcare Low Premium (HMO) with no copay or coinsurance for primary care, specialist, therapy, and telehealth visits. Mental health and psychiatric services require a $25 copay and no coinsurance, while chiropractic services are partially covered since routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Wellcare Low Premium (HMO) partially covers preventive services, offering annual physical exams, alternative therapies, and fitness benefits with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. However, several sub-services are not covered, including health education, weight management, personal emergency response systems (PERS), in-home safety assessments, therapeutic massage, adult day health, and counseling.
Hearing Services See details
Wellcare Low Premium (HMO) provides partially covered hearing services with no copay, no coinsurance, and no deductible for annual routine hearing exams and fitting evaluations. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, but 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 Low Premium (HMO) covers one routine eye exam per year and eyewear—including contact lenses, eyeglasses, lenses, frames, and upgrades—with no copay, no coinsurance, and no deductible. There is a combined maximum eyewear benefit of $100 per year, and prior authorization is required for these services.
Dental Services See details
Wellcare Low Premium (HMO) dental services are partially covered with copays ranging from no copay to $2,250 and no coinsurance, though maxillofacial prosthetics and implant services are not covered. Covered benefits include preventive care like exams and cleanings with no copay, as well as diagnostic, restorative, and orthodontic services with varying copays.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Low Premium (HMO) and require prior authorization. Medicare Part B insulin drugs feature a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Wellcare Low Premium (HMO) covers dialysis services with 20% coinsurance and no copay, although a doctor referral is required.
Medical Equipment See details
Medical equipment benefits under Wellcare Low Premium (HMO) cover durable medical equipment, prosthetic devices, and diabetic 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 services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Wellcare Low Premium (HMO) plan, requiring prior authorization and a doctor referral. Diagnostic tests require a $0 to $25 copay, lab services have no copay, diagnostic radiology has a $0 to $250 copay, outpatient X-rays have a $25 copay, and therapeutic radiology requires a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellcare Low Premium (HMO) with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Cardiac Rehabilitation Services See details
Wellcare Low Premium (HMO) does not cover Cardiac Rehabilitation Services, meaning there is no copay or coinsurance coverage. None of the associated sub-services, including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services, are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Wellcare Low Premium (HMO), requiring prior authorization and a doctor referral but featuring no coinsurance. There is no copay for days 1 to 20 and days 71 to 100, a $218 daily copay for days 21 to 70, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Low Premium (HMO) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and dual eligible SNP services are not covered.
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