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Wellcare Patriot Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Patriot 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 Patriot Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Patriot Simple (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 Patriot Simple (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Patriot 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 Patriot 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Wellcare Patriot Simple (HMO-POS).
Additional Benefits
The Wellcare Patriot Simple (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For specialized care, members pay a $25 copay for specialist visits, while emergency room visits carry a $115 copay that is waived if admitted. Inpatient hospital stays require a daily copay of $400 for the first four days, with no copay for subsequent days. This plan also includes valuable supplemental benefits, such as dental care with no copay up to a $3,000 annual limit, and routine vision and hearing exams with no copay. Additionally, members can access a $1,000 annual hearing aid allowance per ear and covered eyewear up to a $200 yearly limit with no copay. Most medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Wellcare Patriot Simple (HMO-POS) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, you pay a $400 copay per day for days 1-4 and no copay for days 5-90, while psychiatric care costs a $350 copay per day for days 1-4 and no copay for days 5-90. Upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Patriot Simple (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services and a $100 copay for ambulatory surgical center services. Observation services require a $115 to $150 copay per stay with no coinsurance, while outpatient substance abuse and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Patriot Simple (HMO-POS) with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Patriot Simple (HMO-POS), featuring a $250 copay and no coinsurance for ground and air ambulance trips, which require prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Wellcare Patriot Simple (HMO-POS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $35 copay and no coinsurance, with copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Patriot Simple (HMO-POS) covers primary care, mental health, and psychiatric services with no copay and no coinsurance, while specialist visits and therapy services require a $25 copay and no coinsurance. Telehealth is available with a $0 to $35 copay and no coinsurance, but podiatry is not covered, and only some chiropractic services are covered as routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Wellcare Patriot Simple (HMO-POS) preventive services are partially covered, offering an annual physical exam, fitness benefits, and select screenings with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while several supplemental services like health education, nutritional/dietary benefits, and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Patriot Simple (HMO-POS) hearing services are partially covered with no deductible and no coinsurance, featuring a $25 copay for Medicare-covered exams and no copay for annual routine exams or fitting evaluations. Prescription hearing aids are covered up to $1,000 per ear annually with no copay, though inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Wellcare Patriot Simple (HMO-POS) partially covers vision services with no deductibles, offering one routine eye exam per year and eyewear like glasses or contacts with no copay and no coinsurance. While other eye exam services are not covered, covered eyewear benefits require prior authorization and are subject to a $200 annual maximum.
Dental Services See details
Wellcare Patriot Simple (HMO-POS) partially covers dental services, providing Medicare-covered dental care with a $25 copay and no coinsurance. Preventive and most comprehensive dental services are covered with no copay and no coinsurance up to a $3,000 annual maximum, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Patriot Simple (HMO-POS) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B insulin is covered under this benefit with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance between 0% and 20%.
Dialysis Services See details
Wellcare Patriot Simple (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Patriot Simple (HMO-POS) with no copay and 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay, though manufacturer limitations apply, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Wellcare Patriot Simple (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and diagnostic tests with a $0 to $20 copay and no coinsurance. Diagnostic radiology services start at no copay, while therapeutic radiology requires a minimum 20% coinsurance and outpatient X-rays carry a $50 copay with coinsurance.
Home Health Services See details
Wellcare Patriot Simple (HMO-POS) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Wellcare Patriot Simple (HMO-POS) plan with no coinsurance, though only some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered. These specific non-covered services require copayments ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Wellcare Patriot Simple (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is needed. There is no copay for days 1 through 20 and days 61 through 100, while days 21 through 60 require a $218 daily copay, with no coverage provided for additional days beyond the standard 100 days.
Other Services See details
Other services are partially covered by Wellcare Patriot Simple (HMO-POS), which offers over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and a referral is required to access the meal benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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