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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 2026, 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 2026.
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 $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 Simple (HMO-POS) plan features an annual drug deductible of $615. For generic prescription drugs, the plan offers no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications when filled at preferred pharmacies or through preferred mail order. Additionally, Tier 6 (Select Care Drugs) are available with no copay at both preferred and standard locations, including mail order services. For higher-tier medications, costs transition to coinsurance, with Tier 3 (Preferred Brand) and Tier 5 (Specialty Tier) drugs requiring a 25% coinsurance. Tier 4 (Non-Preferred Drugs) carry a 35% coinsurance at preferred pharmacies and a 37% coinsurance at standard pharmacies. Standard pharmacies also charge a copay ranging from $5 to $30 for Tier 1 and Tier 2 generic prescriptions depending on the tier and supply duration.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, home health services, and annual physicals. Specialist visits require a $25 copay, while inpatient hospital stays incur a daily copay of $600 for the first four days of acute care with no coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted, and urgently needed care is available for a $25 copay. For specialized care and supplemental benefits, members enjoy no copay on routine hearing and vision exams, alongside a $200 annual allowance for eyewear and no copay for preventive dental services. Durable medical equipment and dialysis services require a 20% coinsurance with no copay. Additionally, the plan covers over-the-counter items with no copay or coinsurance, helping to keep your everyday wellness expenses low.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $600 daily copay for days 1 through 4 and no copay for days 5 through 100, while psychiatric care requires a $500 daily copay for days 1 through 4 and no copay for days 5 through 90; upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient hospital services with a 30% coinsurance and copays ranging from no copay up to $500, alongside observation services at a $115 copay per stay and 30% coinsurance. Ambulatory surgical center services require a $400 copay and no coinsurance, while outpatient substance abuse sessions carry a $30 copay and no coinsurance. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $105.00 copayment and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $350 copay and no coinsurance, subject to prior authorization. For transportation benefits, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $25 copay, with no coinsurance for either service and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are covered up to a maximum benefit limit of $50,000 with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Covered therapy, psychiatric, mental health, and telehealth services carry copays ranging from $0 to $30 with no coinsurance, though prior authorization is required for most of these benefits. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services under Wellcare Simple (HMO-POS) are partially covered with no copay and no coinsurance for annual physicals, alternative therapies, and select screenings, while kidney disease education requires a 20% coinsurance and no copay. Several supplemental benefits are not covered, including health education, weight management programs, and in-home safety assessments.
Hearing Services See details
Wellcare Simple (HMO-POS) covers Medicare-covered hearing exams with a $25 copay and no coinsurance, plus one routine hearing exam and one fitting evaluation per year with no copay or coinsurance. Hearing aids, including both prescription and over-the-counter options, are not covered under this plan.
Vision Services See details
Vision services under Wellcare Simple (HMO-POS) are partially covered, featuring eye exams with a $0 to $25 copay and eyewear with no copay, both with no coinsurance or deductibles. Routine eye exams (one per year) and up to $200 annually for contact lenses, eyeglasses, frames, and upgrades are covered, while other eye exam services are not covered.
Dental Services See details
Wellcare Simple (HMO-POS) offers partially covered dental services, featuring Medicare-covered dental care for a $25 copay and no coinsurance, and preventive and adjunctive services with no copay and no coinsurance. Specific sub-services that are not covered under this plan include restorative services, endodontics, periodontics, prosthodontics, implant services, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay but are limited to specified manufacturers, and prior authorization is required for most equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO-POS), with prior authorization required for all services. Lab services and diagnostic radiological services feature no copay and no coinsurance, while other diagnostic tests range from a $0 to $75 copay, outpatient X-rays require a $50 copay, and therapeutic radiology has a 20% coinsurance.
Home Health Services See details
Wellcare Simple (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) covers cardiac rehabilitation services with no coinsurance, though copays apply depending on the specific service. You will pay a $30 copay for cardiac rehabilitation, a $40 copay for intensive cardiac rehabilitation, a $25 copay for pulmonary rehabilitation, and a $20 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 71 through 100, while days 21 through 70 require a $218 daily copay, and additional days beyond the Medicare limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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