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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 Statewide in OH. This plan received an overall rating of 3 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 $6500.00 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) Medicare plan features an annual prescription drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or preferred mail order. Additionally, Tier 6 select care drugs have no copay at any network pharmacy, whereas standard pharmacies charge copays starting at $5 for Tier 1 and Tier 2 medications. For brand-name and specialty prescriptions, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 41% coinsurance. These coinsurance percentages remain the same whether you use preferred or standard pharmacies and mail-order services.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits and preventive screenings. Specialist visits require a $35 copay, while emergency room care is covered with a $130 copay that is waived if you are admitted to the hospital within 24 hours. For inpatient hospital stays, members pay a $400 daily copay for days 1 through 7 of an acute stay, followed by no copay for days 8 through 95. This plan also includes robust supplemental benefits to help you save on dental, vision, and hearing care. Routine dental care, annual routine eye exams, and routine hearing evaluations are all available with no copay or coinsurance. Additionally, members receive a $300 annual eyewear allowance, up to $750 per ear annually for prescription hearing aids, and over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital care under Wellcare Simple (HMO-POS) is covered with no coinsurance, requiring a $400 copay for days 1 to 7 of an acute stay (and no copay for days 8 to 95) and a $325 copay for days 1 to 7 of a psychiatric stay (and no copay for days 8 to 90). Prior authorization is required for both benefits, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from no copay up to $450, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization benefits with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under Wellcare Simple (HMO-POS), with ground and air ambulance services requiring prior authorization and a $325 copay with no coinsurance. Transportation services to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Physical, occupational, and speech therapies are covered with a $30 copay and no coinsurance, while podiatry is not covered, and chiropractic services are partially covered with routine and other chiropractic services excluded.
Preventive Services See details
Wellcare Simple (HMO-POS) preventive services are partially covered, offering annual physicals, alternative therapies, fitness benefits, remote access, and screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. Excluded supplemental services include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Wellcare Simple (HMO-POS) partially covers hearing services, offering Medicare-covered exams for a $35 copay and no coinsurance, while routine exams and fitting evaluations have no copay or coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay or coinsurance, but over-the-counter hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Simple (HMO-POS), as other eye exam services are not covered. Covered benefits, such as one annual routine eye exam and eyewear up to a $300 yearly limit, require prior authorization but have no copay and no coinsurance.
Dental Services See details
Wellcare Simple (HMO-POS) provides partially covered dental services, featuring no copay and no coinsurance for preventive and comprehensive care, while Medicare-covered dental services require a $35 copay and no coinsurance. There is a $3,000 annual maximum for covered orthodontic services, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Wellcare Simple (HMO-POS) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic services with no coinsurance, featuring a $0 to $50 copay for diagnostic tests and no copay for lab services. Covered radiological services require prior authorization and include diagnostic radiology with no copay, outpatient X-rays with a $50 copay, and therapeutic radiology with a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are provided by Wellcare Simple (HMO-POS) with no coinsurance, and while some services are covered, cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy (SET) for peripheral artery disease ($25 copay) are not covered.
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 inpatient hospital stay. There is no copay for days 1 to 20 and days 51 to 100, while days 21 to 50 require a $218 daily copay, and additional days beyond the standard 100-day benefit 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, while acupuncture and meal benefits are not covered.
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