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Wellcare Low Premium (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Low Premium (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Low Premium (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Low Premium (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in NJ. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Low Premium (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 Low Premium (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 Low Premium (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.00. 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 Low Premium (HMO-POS) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, you will pay no copay when using preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options are also available for these tiers, with copays starting as low as $5. For higher-tier medications, Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance. Tier 4 non-preferred drugs carry a 35% coinsurance at preferred pharmacies and a 36% coinsurance at standard pharmacies. Choosing preferred network pharmacies and preferred mail-order options typically provides the lowest out-of-pocket costs for your prescriptions.
Additional Benefits
The Wellcare Low Premium (HMO-POS) plan offers comprehensive medical coverage with affordable cost-sharing, including no copays for primary care visits and routine preventive services. Specialist visits, urgent care, and outpatient therapy sessions generally require a low copay of $25 to $35. For more intensive care, inpatient hospital stays require a $375 daily copay for the first seven days with no copay thereafter, while emergency room visits carry a $115 copay that is waived if you are admitted. This plan also features valuable supplemental benefits, featuring no copays for annual routine vision exams, eyewear up to a $100 limit, and preventive dental cleanings. Routine hearing exams and fitting evaluations are also covered with no copay, alongside partial coverage for hearing aids up to $500 per ear. Additionally, beneficiaries pay no copay for home health services, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered under the Wellcare Low Premium (HMO-POS) plan with no coinsurance, requiring a $375 copay per day for days 1 through 7 of an acute stay (with no copay for days 8 through 120) and a $2,075 copay per psychiatric stay. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Wellcare Low Premium (HMO-POS) covers outpatient hospital services with a copay ranging from no copay to $500 and 30% coinsurance, and observation services with a $115 copay per stay and 30% coinsurance. Ambulatory surgical center services require a $250 copay with no coinsurance, outpatient substance abuse sessions carry a $25 copay with no coinsurance, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Wellcare Low Premium (HMO-POS) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellcare Low Premium (HMO-POS) covers Medicare-approved ground and air ambulance services with a $305 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Low Premium (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $25 copay, both with no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Low Premium (HMO-POS) covers primary care physician services and select telehealth benefits with no copay and no coinsurance. Specialist visits, mental health, psychiatric, podiatry, and opioid treatment services require a $25 copay and no coinsurance, physical and occupational therapies require a $35 copay and no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Wellcare Low Premium (HMO-POS) with no copay and no coinsurance for annual physical exams, fitness benefits, remote access technologies, and alternative therapies. Kidney disease education is covered with no copay and a 20% coinsurance, while other additional preventive benefits are partially covered, excluding services like health education, weight management, and in-home support.
Hearing Services See details
Wellcare Low Premium (HMO-POS) covers hearing services with no coinsurance, featuring a $25 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay up to $500 per ear annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Low Premium (HMO-POS) with no deductibles, no coinsurance, and no copays for one annual routine eye exam and eyewear up to a $100 yearly limit, though other eye exam services are not covered.
Dental Services See details
Wellcare Low Premium (HMO-POS) covers Medicare dental services with a $25 copay and no coinsurance, and preventive dental services like exams, cleanings, and x-rays with no copay and no coinsurance. However, dental benefits are only partially covered, as restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Low Premium (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Low Premium (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Low Premium (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies from specified manufacturers are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Low Premium (HMO-POS) with prior authorization, offering diagnostic services with no coinsurance, no copay for labs, and diagnostic test copays between $0 and $75. Radiological services include outpatient X-rays for a $50 copay, diagnostic radiology starting at no copay, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Wellcare Low Premium (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Low Premium (HMO-POS) covers cardiac rehabilitation services with no coinsurance. Covered services include standard cardiac rehabilitation with a $30 copay, intensive cardiac rehabilitation with a $40 copay, pulmonary rehabilitation with a $25 copay, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) with a $20 copay.
Skilled Nursing Facility (SNF) See details
Wellcare Low Premium (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 to 20 and 71 to 100, a $218 daily copay for days 21 to 70, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Low Premium (HMO-POS) partially covers other services, offering acupuncture with no copay and no coinsurance for up to 24 treatments per year with prior authorization. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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