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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 2025, 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 out of 5 stars in 2025.
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 $37.00. 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 Low Premium (HMO) plan has a $420.00 deductible for prescription drugs. After the deductible is met, you'll pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll have no copay if you use a preferred pharmacy or mail order, or a $10.00 copay if you use a standard pharmacy. Specialty drugs have no copay. Other drugs have coinsurance costs that range from 25% to 35% of the cost of the drug.
Additional Benefits
The Wellcare Low Premium (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $400 copay for the first six days, with no copay for days 7-90. Outpatient services have a mix of copays and coinsurance, while emergency services have a $140 copay. The plan includes no copay for many primary care services, preventive services, hearing exams, vision exams, and dental cleanings. Additional benefits include coverage for ambulance services with a $300 copay, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a $400 copay for days 1-6 and no copay for days 7-90. Additional days and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
The Wellcare Low Premium (HMO) plan covers outpatient services, including outpatient hospital services with a 35% coinsurance and a copay between $0 and $350, and observation services with a 35% coinsurance and a $140 copay. The plan also covers ambulatory surgical center services with a $300 copay, outpatient substance abuse services with no copay, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, requiring prior authorization and a doctor referral, with a copay of $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a $300 copay, and there is no coinsurance. 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 under the Wellcare Low Premium (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay and no coinsurance, while Urgently Needed Services have a $25 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Low Premium (HMO) plan covers primary care physician services, chiropractic services (with no copay), occupational therapy, physician specialist services (with no copay), mental health specialty services (with no copay), podiatry services (with no copay), other health care professional services (with no copay), psychiatric services (with no copay), physical therapy and speech-language pathology services (with no copay), additional telehealth benefits (with a copay between $0 and $25), and opioid treatment program services (with no copay). However, routine chiropractic care is not covered.
Preventive Services See details
The Wellcare Low Premium (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like alternative therapies, fitness benefits, and remote access technologies are covered with no copay. Kidney disease education services are covered with 20% coinsurance. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered with no copay.
Hearing Services See details
Wellcare Low Premium (HMO) covers hearing exams and routine hearing exams with no copay, as well as fitting/evaluation for hearing aids with no copay, but prescription hearing aids are covered with a $350 maximum plan benefit. OTC hearing aids, and some prescription hearing aid types are not covered.
Vision Services See details
Vision services, including routine eye exams and eyewear, are covered. Eye exams and eyewear have no copay, while eyewear has a combined maximum benefit of $100 per year.
Dental Services See details
The Wellcare Low Premium (HMO) plan covers dental services 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 treatment have no copay; 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 has a copay between $0 and $70; and orthodontics has a copay between $0 and $2250.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Low Premium (HMO) plan, and require prior authorization. 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 Low Premium (HMO) plan, but a doctor referral is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Wellcare Low Premium (HMO) plan. Durable Medical 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 have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $350, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $25 copay. All services require prior authorization and a doctor's referral.
Home Health Services See details
Home Health Services are covered by the Wellcare Low Premium (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 under the Wellcare Low Premium (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 under the Wellcare Low Premium (HMO) plan. For days 1-20 and 41-100, there is no copay, but for days 21-40, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are not covered by the Wellcare Low Premium (HMO) plan, including acupuncture, over-the-counter items, meal benefits, and more. No authorization or referrals are required for these services.
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