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Wellcare Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in All counties in CT. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Simple (HMO-POS) 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 Simple (HMO-POS).
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 Simple (HMO-POS), 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 $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 $7550.00 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 Simple (HMO-POS) plan has a $420 deductible for prescription drugs. Once you meet your deductible, you'll pay either a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, there is no copay at preferred pharmacies and mail order, while standard pharmacies have a $10 copay. Specialty drugs and drugs for those with LIS have no copay. During the initial coverage phase, your drug costs will be covered until your total drug costs reach $2000. After this, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, with no copay for most days, while outpatient services may have coinsurance or copays. The plan covers primary care, specialist visits, and mental health services with copays. Preventive, hearing, vision, and dental services are included, often with no copay, and with maximums for some services. The plan also covers ambulance, emergency, home health, and skilled nursing facility services, usually with copays or coinsurance. Additionally, this plan provides coverage for over-the-counter items and meal benefits, but certain services like private duty nursing and some cardiac rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $575 for days 1-4, and no copay for days 5-90 for Inpatient Hospital-Acute, and a copay of $500 for days 1-4, and no copay for days 5-90 for Inpatient Hospital Psychiatric; additional days for Inpatient Hospital-Acute are covered with no copay for days 91-100. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 30% coinsurance and a copay between $0 and $500, Observation Services with a 30% coinsurance and a $110 copay, Ambulatory Surgical Center (ASC) Services with a $150 copay, and Outpatient Substance Abuse Services with a $30 copay for individual and group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple (HMO-POS) plan. Ground and air ambulance services have a $300 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered under the Wellcare Simple (HMO-POS) plan with a $110 copay, while Urgently Needed Services have a $25 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $30 copay, and specialist services with a $25 copay. This plan also covers mental health and psychiatric services, with a $30 copay for individual and group sessions. Additionally, physical therapy and speech-language pathology services have a $30 copay, and telehealth services have a copay between $0 and $30.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, while Additional Preventive Services may have a copay. Additional services such as health education, in-home safety assessments, and more are not covered. Kidney Disease Education Services have a 20% coinsurance, and Other Preventive Services such as Glaucoma Screenings and Diabetes Self-Management Training have no copay.
Hearing Services See details
The Wellcare Simple (HMO-POS) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but the plan does not cover Prescription Hearing Aids - Inner Ear, Outer Ear, or Over the Ear. OTC hearing aids are not covered.
Vision Services See details
The Wellcare Simple (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$25, and eyewear with no copay. Routine eye exams have no copay, and you are allowed one exam per year. The plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with no copay. There is a combined maximum plan benefit coverage amount of $200 per year for eyewear.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $25 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay. Orthodontic Services are covered up to a $1500 maximum per year, while prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 Simple (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits under the Wellcare Simple (HMO-POS) plan include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Supplies with no copay; Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and lab services with no copay, and diagnostic procedures/tests with a copay between $0 and $30. Radiological services are covered, including diagnostic radiological services with a copay up to $500, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $50 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Simple (HMO-POS) plan, but no specific information is given about the cost of services. However, the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Wellcare Simple (HMO-POS) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, while days 21-60 have a $214 copay.
Other Services See details
Other Services includes coverage for over-the-counter items with no copay and a maximum benefit of $38.00 every three months, and meal benefits with no copay and requiring a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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