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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 $47.00. 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 $6200.00 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 offers an Enhanced Alternative drug benefit with a yearly prescription drug deductible of $615.00. If you qualify for the Extra Help low-income subsidy, your Part D cost is reduced to $0.00. Once the deductible is met, you enter the initial coverage phase where costs are determined by the drug's tier and your choice of pharmacy. For Tier 1 preferred generics, there is no copay at preferred pharmacies and a $10.00 copay at standard pharmacies, while Tier 5 specialty drugs feature no copay at either pharmacy type. Other tiers require a coinsurance, ranging from 25% for standard generics and non-preferred drugs up to 36% for preferred brands. After your 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 Low Premium (HMO) provides cost-effective coverage for essential medical services, featuring no copay for primary care visits and a $40 copay for specialists. Emergency room visits require a $130 copay, while urgent care is available for a $25 copay. For inpatient hospital stays, members pay a $390 copay for days 1 to 6, with no copay for days 7 to 90. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing services with no copays for standard annual exams. Covered dental procedures require no coinsurance and carry copays up to $2,250, while diagnostic lab services are fully covered with no copay. Durable medical equipment and diabetic shoes are subject to a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Wellcare Low Premium (HMO) with a $390 copay for days 1 to 6, no copay for days 7 to 90, and no coinsurance for acute and psychiatric stays. Doctor referrals and prior authorizations are required, and the plan does not cover upgrades, additional days, or non-Medicare-covered stays.
Outpatient Services See details
Wellcare Low Premium (HMO) covers outpatient services, offering outpatient blood and substance abuse services with no copay and no coinsurance. Ambulatory surgical center services carry a $300 copay and no coinsurance, while outpatient hospital and observation services require a 35% coinsurance and copays ranging from $0 to $350.
Partial Hospitalization See details
Wellcare Low Premium (HMO) covers partial hospitalization benefits with a $140.00 copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Wellcare Low Premium (HMO), which covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Wellcare Low Premium (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum, requiring a $130 copay and no coinsurance for emergency and urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits offered by Wellcare Low Premium (HMO) feature no copays and no coinsurance for primary care visits, occupational therapy, physical therapy, and mental health or psychiatric sessions. Specialist visits, podiatry, and opioid treatment require a $40 copay with no coinsurance, telehealth and other health professionals range from a $0 to $40 copay with no coinsurance, and routine chiropractic care is not covered.
Preventive Services See details
Wellcare Low Premium (HMO) partially covers preventive services with no copay and no coinsurance for annual exams, alternative therapies, fitness benefits, and screenings, while kidney disease education requires a 20% coinsurance and no copay. However, sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Wellcare Low Premium (HMO) provides partially covered hearing services, with a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams, fittings, and covered prescription hearing aids up to $350 per ear. 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 vision services with no deductibles or coinsurance, including no copay for annual routine eye exams and a copay of up to $40 for other exams. Eyewear, such as contacts and eyeglasses, is also covered with no copay up to a combined annual maximum benefit of $100.
Dental Services See details
Wellcare Low Premium (HMO) partially covers dental services, with maxillofacial prosthetics and implant services excluded from coverage. Covered services require no coinsurance, with copays ranging from no copay up to $2,250 depending on the specific treatment.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Wellcare Low Premium (HMO) with prior authorization. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Wellcare Low Premium (HMO) covers dialysis services with no copay and a 20% coinsurance, though a doctor referral is required.
Medical Equipment See details
Wellcare Low Premium (HMO) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic shoes or inserts with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, though prior authorization is required for most of these medical equipment benefits.
Diagnostic and Radiological Services See details
Wellcare Low Premium (HMO) covers diagnostic and radiological services, which require prior authorization and a doctor referral. Members pay no copay or coinsurance for diagnostic tests, procedures, and lab services. Radiological services feature a $25 copay (no coinsurance) for outpatient X-rays, a copay up to $350 (no coinsurance) for diagnostic radiology, and a 20% coinsurance (no copay) for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Wellcare Low Premium (HMO) with no copay and no coinsurance, though a doctor referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Wellcare Low Premium (HMO) states that some services are covered under the Cardiac Rehabilitation Services benefit, but in practice, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Because these services are not covered, there is no copay or coinsurance coverage available.
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. There is no coinsurance, with no copay for days 1 to 20 and days 51 to 100, a $218 daily copay for days 21 to 50, and no coverage for additional days beyond the Medicare-covered limit.
Other Services See details
Other Services are not covered under the Wellcare Low Premium (HMO) plan, which provides no coverage for acupuncture, over-the-counter (OTC) items, meal benefits, or dual-eligible SNPs.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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