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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 2025, 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 out of 5 stars in 2025.
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 $41.00. 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 $590.00 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 $7550.00 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) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. The plan offers a variety of copays and coinsurance rates, so be sure to check the plan's formulary for your specific medications. For example, preferred generic drugs have a $19 copay at preferred pharmacies, and a $20 copay at standard pharmacies. Specialty tier drugs have no copay at preferred pharmacies, and a $4 copay at standard pharmacies. Once your total yearly drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with varying copays and coinsurance, and emergency services with a $110 copay. You'll find coverage for primary care with no copay, along with benefits for vision, dental, hearing, and home health services. Additional benefits include coverage for preventive services with no copay for many services, as well as coverage for medical equipment, and diagnostic and radiological services. This plan also includes coverage for skilled nursing facilities and cardiac rehabilitation, as well as coverage for outpatient substance abuse services and partial hospitalization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered. For Inpatient Hospital-Acute, you pay a $375 copay for days 1-7, and no copay for days 8-90, and for Additional Days, you pay no copay for days 91-120. Inpatient Hospital Psychiatric has a $465 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a 20% coinsurance and a copay ranging from $0 to $300, while Observation Services have a 20% coinsurance and a $110 copay. Ambulatory Surgical Center (ASC) Services have a $250 copay, and Outpatient Substance Abuse Services have a $25 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist (HMO-POS) plan, but requires prior authorization. You will have an $80 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Assist (HMO-POS) plan. Ground and Air Ambulance Services each have a $325 copay, and there is no coinsurance. 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 under the Wellcare Assist (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, and Urgently Needed Services have a $25 copay; all three services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist (HMO-POS) plan offers primary care services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $30 copay. It also covers physician specialist services with a $25 copay, and mental health specialty, psychiatric, and opioid treatment program services with a $25 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay, while additional telehealth benefits range from no copay to a $30 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services with varying copays depending on the service. Kidney Disease Education Services have a 20% coinsurance, while other preventive services include services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services are covered by the Wellcare Assist (HMO-POS) plan. Hearing exams have a $25 copay, but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids of all types, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay but are limited to a combined maximum of $100 per year.
Dental Services See details
Wellcare Assist (HMO-POS) covers Medicare Dental Services with a $25 copay, and covers Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Fluoride Treatment with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery are covered with 20% coinsurance. Orthodontic Services have a $1000 maximum benefit, and Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Assist (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Wellcare Assist (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. 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, including Diagnostic Procedures/Tests with a copay between $0 and $50, Lab Services with no copay, Diagnostic Radiological Services with a copay of up to $300, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with a $50 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Assist (HMO-POS) plan, but none of the listed sub-services are covered. The plan's cost sharing for this benefit includes a copay, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Assist (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, up to a maximum of $40 every three months. 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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