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Wellcare Specialty Simple Focus (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Specialty Simple Focus (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Specialty Simple Focus (HMO C-SNP) in 2026, please refer to our full plan details page.
Wellcare Specialty Simple Focus (HMO C-SNP) is a HMO C-SNP plan offered by Centene Corporation available for enrollment in 2026 to people living in San Francisco. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Specialty Simple Focus (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Specialty Simple Focus (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Specialty Simple Focus (HMO C-SNP).
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 Specialty Simple Focus (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $9250.00 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 Specialty Simple Focus (HMO C-SNP) plan features an annual prescription drug deductible of $615.00. After meeting this deductible, you enter the initial coverage phase where Tier 1 preferred generics have no copay at preferred pharmacies but require a $10.00 copay at standard pharmacies. Additionally, you will pay a 25% coinsurance for Tier 2 standard generics and Tier 4 non-preferred drugs, a 35% coinsurance for Tier 3 preferred brands, and no copay for Tier 5 specialty drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. If you qualify for the low-income subsidy, or Extra Help, your Part D costs can be reduced to $0.00. This plan provides an enhanced alternative benefit design to help manage your medication expenses.
Additional Benefits
The Wellcare Specialty Simple Focus (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, physical therapy, and home health services. Specialized care, including specialist visits, outpatient services, and emergency room care, features low to moderate copays and no coinsurance. Inpatient hospital stays require an $800 copay for the first two days, with no copay for days three through ninety. Routine vision, hearing, and dental exams are available with no copay, alongside coverage for eyewear, prescription hearing aids, and selective dental services. While diabetic supplies and therapeutic shoes require no copay or coinsurance, other durable medical equipment and dialysis services are covered with a 20% coinsurance. Additionally, members benefit from acupuncture and over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Wellcare Specialty Simple Focus (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with an $800 copay for days 1-2, no copay for days 3-90, and no coinsurance. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Specialty Simple Focus (HMO C-SNP) covers outpatient services with no coinsurance and copays that vary by the specific service. Outpatient hospital services range from no copay to a $300 copay, observation services require a $115 to $300 copay, ambulatory surgical center visits have a $150 copay, outpatient substance abuse services carry a $25 copay, and blood services are covered with no copay.
Partial Hospitalization See details
Wellcare Specialty Simple Focus (HMO C-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered benefits.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Wellcare Specialty Simple Focus (HMO C-SNP), with ambulance services covered but transportation services to health-related locations not covered. Covered ground and air ambulance services require a $200 copay and no coinsurance, and prior authorization is required.
Emergency Services See details
Wellcare Specialty Simple Focus (HMO C-SNP) covers emergency services with a $115 copay and urgently needed services with no copay, both featuring no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Specialty Simple Focus (HMO C-SNP) covers primary care physician visits, physical therapy, and occupational therapy with no copay and no coinsurance. Specialist visits, psychiatric care, routine chiropractic, and podiatry services are also covered with copays ranging from $15 to $25 and no coinsurance.
Preventive Services See details
Wellcare Specialty Simple Focus (HMO C-SNP) provides partial coverage for preventive services with no copays or coinsurance for covered benefits like annual physicals and kidney disease education. However, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, fitness, disease management, telemonitoring, bathroom safety, and counseling.
Hearing Services See details
Wellcare Specialty Simple Focus (HMO C-SNP) offers partially covered hearing services with no deductibles or coinsurance, featuring a $25 copay for Medicare-covered exams and no copay for routine exams and fitting evaluations. Prescription hearing aids (all types) are covered with no copay, but OTC hearing aids and specific prescription types—including inner ear, outer ear, and over the ear—are not covered.
Vision Services See details
Wellcare Specialty Simple Focus (HMO C-SNP) covers vision services with no coinsurance, offering routine eye exams with no copay and other eye exams with a copay between $0 and $25. Eyewear, including contacts and eyeglasses, is also covered with no copay and no coinsurance up to an annual combined maximum benefit of $100.
Dental Services See details
Dental services are partially covered by Wellcare Specialty Simple Focus (HMO C-SNP), excluding maxillofacial prosthetics and orthodontics. Medicare-covered dental services require a $25 copay and no coinsurance, while other covered dental services have no copay and no coinsurance, subject to a $70 monthly maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Specialty Simple Focus (HMO C-SNP) and require prior authorization, featuring a $35 copay and no coinsurance for Part B insulin. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and have a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered by Wellcare Specialty Simple Focus (HMO C-SNP) with a 20% coinsurance and no copay, though a doctor referral is required.
Medical Equipment See details
Wellcare Specialty Simple Focus (HMO C-SNP) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies, therapeutic shoes, and inserts are also covered with no copay and no coinsurance, though prior authorization is required for all of these medical equipment benefits.
Diagnostic and Radiological Services See details
Wellcare Specialty Simple Focus (HMO C-SNP) covers diagnostic and radiological services, which require a doctor referral and prior authorization. Diagnostic tests and lab services have no copayments or coinsurance, while outpatient X-rays require a $50 copay, diagnostic radiology ranges from a $0 to $200 copay, and therapeutic radiology requires 20% coinsurance with no copays.
Home Health Services See details
Wellcare Specialty Simple Focus (HMO C-SNP) covers home health services with no copay and no coinsurance. A doctor referral and prior authorization are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Specialty Simple Focus (HMO C-SNP) plan, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
Wellcare Specialty Simple Focus (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and days 71 to 100, and a $218 copay for days 21 to 70. Prior authorization and a doctor referral are required for these services, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Specialty Simple Focus (HMO C-SNP), offering acupuncture and over-the-counter items with no copay and no coinsurance. Meal benefits and dual-eligible SNPs with highly integrated services are not covered under this benefit.
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