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Wellcare Giveback (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Giveback (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 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Giveback (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 Giveback (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 Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $98.60. You must continue to pay paying your reduced 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 $7500.00 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 Giveback (HMO-POS) plan has a $420 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and where you fill your prescription. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies and preferred mail order, and a $10 copay at standard pharmacies and standard mail order. Specialty drugs in Tier 5 have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Giveback (HMO-POS) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with coinsurance, and emergency services with a copay. Primary care and preventive services, such as an annual physical exam, have no copay. Vision and dental services are covered, with eye exams and eyewear having no copay. This plan also provides coverage for hearing exams, ambulance services, and home health services with no copay. Additionally, you'll find benefits like over-the-counter items, home infusion services, and durable medical equipment with coinsurance or copays. However, some services like cardiac rehabilitation, additional hours of care, and certain dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $455 copay for days 1-5 and no copay for days 6-90; for Inpatient Hospital Psychiatric, you'll pay a $400 copay for days 1-5 and no copay for days 6-90. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a 30% coinsurance and no copay, observation services with a $110 copay and 30% coinsurance, ambulatory surgical center services with a minimum and maximum 20% coinsurance, outpatient substance abuse services with a minimum and maximum 20% coinsurance for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Giveback (HMO-POS) plan, with a $80 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Giveback (HMO-POS) plan. All ambulance services have no copay, but require a 30% coinsurance for both ground and air ambulance services. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Giveback (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay, and all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $15 copay, but routine care is not covered. Occupational Therapy Services have a $35 copay, but no coinsurance. Physician Specialist Services have a $50 copay. Mental Health Specialty Services, including Individual and Group Sessions, have 20% coinsurance. Other Health Care Professional services have a copay between $0 and $50. Psychiatric Services, including Individual and Group Sessions, have 20% coinsurance. Physical Therapy and Speech-Language Pathology Services have a $35 copay, with no coinsurance. Additional Telehealth Benefits have 20% coinsurance and a copay between $0 and $50. Opioid Treatment Program Services have a $50 copay.
Preventive Services See details
The Wellcare Giveback (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Kidney Disease Education Services has a 20% coinsurance. Some additional preventive services are not covered, including health education, in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing exams are covered with a $50 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Giveback (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$50 and eyewear with no copay. Eyewear has a combined maximum plan benefit coverage amount of $200 per year.
Dental Services See details
The Wellcare Giveback (HMO-POS) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Medicare dental services have a $50 copay. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance may be between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Giveback (HMO-POS) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the Wellcare Giveback (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Giveback (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of at most 30% and no copay, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback (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 not covered by the Wellcare Giveback (HMO-POS) plan. 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) services are covered, but require prior authorization. For days 1-20 and 61-100, there is no copay, and for days 21-60, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Wellcare Giveback (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $40 every three months. Other services such as Acupuncture, Meal Benefit, 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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