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 offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you enter the initial coverage phase until your total drug costs reach $2,100.00, with potential premium reductions down to $0.00 for those qualifying for Extra Help. Under this plan, Tier 1 preferred generics and Tier 5 specialty drugs feature no copay at preferred pharmacies, while standard pharmacies charge a $10.00 copay for Tier 1 drugs. Tier 2 standard generics and Tier 4 non-preferred drugs require a 25% coinsurance, and once your out-of-pocket costs hit $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions.

Additional Benefits

The Wellcare Low Premium (HMO) plan offers robust coverage with many services requiring no copayments or coinsurance, including primary care, specialist visits, home health services, and annual preventive screenings. For hospital stays, members pay a $375 copay per day for the first seven days of acute inpatient care, while emergency room visits carry a $150 copay. Outpatient services are also accessible, featuring no coinsurance and outpatient hospital visit copays ranging from no copay up to $350. This plan provides valuable supplemental benefits, featuring no copays or coinsurance for routine vision exams, annual hearing tests, and preventive dental care. Members also benefit from a $100 annual eyewear allowance and coverage for up to two prescription hearing aids per year with a $500 maximum per ear. Additionally, diabetic supplies are fully covered with no copay or coinsurance, while other durable medical equipment requires a standard 20% coinsurance.