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Wellcare Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Assist (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 Assist (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 Assist (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 Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.20. 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 Assist (HMO-POS) prescription drug plan features an annual drug deductible of $615. Tier 6 select care drugs have no copay across all standard, preferred, and mail-order options. Generic drugs under Tiers 1 and 2 offer copays starting as low as $10 at preferred pharmacies, with no copay for a three-month supply when filled through preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. Tier 4 non-preferred drugs carry a $100 copay for a one-month supply at both preferred and standard pharmacies. Choosing preferred pharmacies and preferred mail-order services helps policyholders minimize their out-of-pocket drug expenses.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialized care, members pay a $25 copay for specialist visits and a $115 copay for emergency room services, which is waived if admitted. Inpatient hospital stays require a $375 copay per day for the first seven days with no copay for subsequent days, while outpatient hospital services carry 30% coinsurance and no copay. This plan also includes essential supplemental benefits, providing routine dental, vision, and hearing exams with no copay. Comprehensive dental services are covered with no copay and a 20% coinsurance up to a $1,000 annual limit, while routine eyewear is covered up to $100 annually. Additionally, durable medical equipment, diabetic supplies, and dialysis services are accessible, with diabetic supplies featuring no copay and other equipment requiring a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by Wellcare Assist (HMO-POS) with no coinsurance, requiring a $375 copay for days 1 through 7 of acute stays and a $295 copay for days 1 through 7 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and non-Medicare-covered stays, psychiatric additional days, and upgrades are not covered.
Outpatient Services See details
Wellcare Assist (HMO-POS) covers outpatient hospital services with no copay and 30% coinsurance, observation services with a $115 copay per stay and 30% coinsurance, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse sessions require a $25 copay and no coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Assist (HMO-POS) with a $105.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services under Wellcare Assist (HMO-POS) require prior authorization and carry a $325 copay with no coinsurance for both ground and air transport. Although transportation services are technically listed, trips to plan-approved or health-related locations are not covered.
Emergency Services See details
Wellcare Assist (HMO-POS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO-POS) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Other covered benefits like physical, occupational, and speech therapy carry a $30 copay with no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Assist (HMO-POS) preventive services are partially covered, offering annual physicals, select screenings, fitness benefits, alternative therapies, and remote access with no copay and no coinsurance, while kidney education requires a 20% coinsurance and no copay. Sub-services not covered under this plan include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Wellcare Assist (HMO-POS) covers Medicare-covered hearing exams with a $25 copay and no coinsurance, as well as one routine hearing exam and one fitting evaluation annually with no copay and no coinsurance. There is no deductible for these services, but prescription hearing aids (including inner ear, outer ear, and over-the-ear types) and OTC hearing aids are not covered.
Vision Services See details
Wellcare Assist (HMO-POS) offers partially covered vision services with no deductibles and no coinsurance, featuring no copay for annual routine eye exams and eyewear up to a $100 yearly limit. Prior authorization is required, eye exam copays range from $0 to $25, and other eye exam services are not covered.
Dental Services See details
Wellcare Assist (HMO-POS) partially covers dental services, offering Medicare-covered dental for a $25 copay and no coinsurance, alongside preventive care with no copay and no coinsurance. Comprehensive services like restorative care and periodontics are covered with no copay and a 20% coinsurance up to a $1,000 annual limit, but prosthodontics, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Assist (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs are covered with 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Assist (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are available with no copay, and diabetic therapeutic shoes or inserts are covered with a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Assist (HMO-POS) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for lab services, and a $0 to $50 copay for tests. Radiological services include diagnostic radiology with no coinsurance, 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 Wellcare Assist (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Assist (HMO-POS) with no coinsurance, although only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Assist (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.
Other Services See details
Wellcare Assist (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance via reimbursement. Acupuncture and meal benefits are not covered under this plan.
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