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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 $20.00. 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 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy used. For the initial coverage phase, preferred generic drugs have no copay at preferred pharmacies and mail order, but have a $10 copay at standard pharmacies. Standard generic drugs have a 25% coinsurance, and preferred brand drugs have a 36% coinsurance. Specialty tier drugs have no copay.
Additional Benefits
The Wellcare Low Premium (HMO) plan offers comprehensive coverage with a focus on keeping costs low for common services. This plan provides coverage for inpatient hospital stays, with a copay for the first few days, and outpatient services like primary care, and preventive services with no copay. Additional benefits include coverage for hearing, vision, and dental services, with no copays for many services. The plan also covers medical equipment, home health services, and other services like acupuncture. However, it's important to note that this plan does not cover cardiac rehabilitation services or additional hours of home health care.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-6, the copay is $325, and for days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-120. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $350, observation services have a copay between $140 and $350, ASC services have a $250 copay, and outpatient blood services have no copay. Outpatient substance abuse services have a $25 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Low Premium (HMO) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Low Premium (HMO) plan. Ground and Air Ambulance Services each have a $250 copay, but there is no coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have copays of $140, $25, and $140 respectively, with 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, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, and speech-language pathology services have no copay, while mental health and psychiatric services have a $25 copay for individual and group sessions. Additional telehealth benefits have a copay ranging from $0 to $25.
Preventive Services See details
The Wellcare Low Premium (HMO) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services with varying copays. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services are covered, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum benefit of $750 per ear every year, and no copay for Prescription Hearing Aids (all types). 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, including eye exams and eyewear, are covered. Eye exams and eyewear have no copay. Routine eye exams are limited to one per year. Eyewear has a combined maximum benefit of $100 per year.
Dental Services See details
Dental services are covered, including oral exams and dental x-rays with no copay, other diagnostic dental services with a $15 copay, prophylaxis (cleaning) with no copay, fluoride treatment with no copay, other preventive dental services with a copay between $0 and $55, and orthodontics with a copay between $0 and $2250. 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. 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 with a doctor referral, and the coinsurance is 20%.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Low Premium (HMO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, with no copay for Diabetic Supplies, and 20% coinsurance for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests and Lab Services with no copay, and Diagnostic Radiological Services with a copay of at most $350.00. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no 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 referrals are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Low Premium (HMO) plan. A doctor referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by 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 coverage and non-Medicare-covered stays for SNF are not covered.
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 items, meal benefits, and many other services are not covered. This plan requires prior authorization and a doctor referral for acupuncture.
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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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