A non-government entity
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 $36.00. 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:
Sign up for Wellcare Low Premium (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Low Premium (HMO) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For those who qualify for the low-income subsidy (LIS), the monthly premium for Part D drugs is $7. For preferred generic drugs, you may have no copay, while other tiers have coinsurance or copays. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Wellcare Low Premium (HMO) plan offers comprehensive coverage with a focus on outpatient services. This plan includes no copay for primary care, preventive services, hearing exams, vision exams, and many dental services, as well as a $350 copay for inpatient hospital stays. The plan also covers emergency services, home health services, and skilled nursing facilities, but with varying copays and coinsurance depending on the service.
Inpatient Hospital See details
The Wellcare Low Premium (HMO) plan covers inpatient hospital stays with a copay of $350 for days 1-6 and no copay for days 7-90. Additional days for inpatient hospital-acute are covered with no copay for days 91-120, up to 30 additional days per benefit period. Non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered.
Outpatient Services See details
The Wellcare Low Premium (HMO) plan covers outpatient services including outpatient hospital services with a copay between $0 and $350, observation services with a copay between $140 and $350, and ambulatory surgical center services with a $250 copay. Outpatient substance abuse services have a copay of $25, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Low Premium (HMO) plan, with a $130 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Low Premium (HMO) plan. Ground and Air Ambulance Services have a $250 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Wellcare Low Premium (HMO) plan. Emergency Services have a $140 copay and no coinsurance, while Urgently Needed Services have a $25 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage also have a $140 copay and no coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Low Premium (HMO) plan offers primary care services with no copay, and chiropractic services and routine chiropractic care with no copay. Occupational therapy, physical therapy, and speech-language pathology services are covered, but require a referral and authorization. Physician specialist services and mental health specialty services are covered, with individual and group sessions for mental health specialty services having a $25 copay. Podiatry services, other health care professional services, and psychiatric services are covered, but require a referral and authorization. Additional telehealth benefits are covered with a copay between $0 and $25, and opioid treatment program services are covered with no copay.
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 and fitness benefits 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 EKG following Welcome Visit have no copay.
Hearing Services See details
The Wellcare Low Premium (HMO) plan covers hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum benefit of $750 per year, and no copay for all types of prescription hearing aids. OTC hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear with no copay, and eyewear has a combined maximum plan benefit of $100 per year. Routine eye exams are covered once per year with no copay, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are all covered with no copay.
Dental Services See details
Dental services include coverage for Medicare Dental Services with no copay, oral exams and dental x-rays with no copay, and other diagnostic dental services with a $15 copay. Additional services include prophylaxis (cleaning), fluoride treatment, and other preventive dental services with copays ranging from $0 to $55. Orthodontic services include restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery, and orthodontics with varying copays. 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 Low Premium (HMO) plan, and require a doctor's referral. 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 prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, and Diagnostic Radiological Services with a copay of up to $350. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Low Premium (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and referral are required for this benefit.
Cardiac Rehabilitation Services See details
Wellcare Low Premium (HMO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. A doctor referral is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Low Premium (HMO) plan, with prior authorization and a doctor's referral required. You will have no copay for days 1-20 and days 41-100, and a $214 copay for days 21-40.
Other Services See details
The Wellcare Low Premium (HMO) plan covers acupuncture with no copay and a limit of 24 treatments per year, but other services such as Over-the-Counter (OTC) Items, Meal Benefit, and several other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved