Wellcare Low Premium (HMO)

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.

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:

Drug Coverage

The Wellcare Low Premium (HMO) plan features an annual prescription drug deductible of $615.00. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies, while standard pharmacies charge a $10.00 copay. Tier 5 specialty drugs also feature no copay at both preferred and standard pharmacies, while Tier 2 standard generics and Tier 4 non-preferred drugs require a 25% coinsurance. For Tier 3 preferred brand drugs, the plan requires a 35% coinsurance at preferred pharmacies and 36% coinsurance at standard pharmacies. Once your annual out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for Extra Help may see their Part D premium reduced to $9.70.

Additional Benefits

The Wellcare Low Premium (HMO) plan offers robust coverage with no copay and no coinsurance for primary care visits, specialists, routine preventive care, and home health services. For inpatient hospital stays, members pay a $350 daily copay for the first six days and no copay for days seven through ninety. Emergency room visits require a $150 copay, which is waived if you are hospitalized within 24 hours. Essential specialty benefits like routine vision exams, hearing evaluations, and preventive dental care are also covered with no copay and no coinsurance. Diagnostic lab tests are available with no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Many of these services, including outpatient procedures and medical equipment, require prior authorization or a doctor referral.