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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 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 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 $58.50. 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 $8850.00 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 the pharmacy you use. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. The plan covers specialty drugs with no copay.
Additional Benefits
The Wellcare Giveback (HMO-POS) plan offers a range of benefits with varying cost-sharing. You can expect no copay for primary care visits, preventive services like annual physical exams, and some vision and dental services. The plan does have copays for inpatient hospital stays, outpatient services, specialist visits, hearing exams, and emergency services. The plan also provides coverage for services like home health, skilled nursing facilities, and dialysis, with specific copays or coinsurance amounts. Some services, such as hearing exams, vision, and dental, have no copay for certain services, but have a copay for other services. The plan also includes some additional benefits, but it is important to note that some services like cardiac rehabilitation and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Wellcare Giveback (HMO-POS) plan. For Inpatient Hospital-Acute, the copay is $1545 per admission or stay. For Inpatient Hospital Psychiatric, the copay is $1872 per admission or stay.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $475, observation services with a copay between $110 and $475, Ambulatory Surgical Center (ASC) Services with a $250 copay, individual and group outpatient substance abuse sessions with a $40 copay, and outpatient blood services with no copay. All services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Giveback (HMO-POS) plan, with a copay of $80. Prior authorization is required.
Ambulance and Transportation Services See details
For Wellcare Giveback (HMO-POS), ambulance services are covered with a $260 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services include a $110 copay, while Urgently Needed Services have a $40 copay, and both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Giveback (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, but routine care is not covered. Occupational therapy services have a $35 copay, while physician specialist services have a $50 copay. Mental health specialty services, individual and group sessions, have a $40 copay. Other health care professionals have a copay between $0 and $50, and psychiatric services, individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a copay between $0 and $50. Opioid treatment program services have a $50 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional services like Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit also have no copay. Other services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, 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 are not covered. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
The Wellcare Giveback (HMO-POS) plan covers hearing exams with a $50 copay, and also covers routine hearing exams and fitting/evaluation for hearing aids with no copay, once per year. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Wellcare Giveback (HMO-POS) covers vision services, including eye exams with a copay of $0-$50, and eyewear with no copay. Routine eye exams are covered with no copay once per year, and eyewear has a combined maximum benefit of $100 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, other preventive dental services, and adjunctive general 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 by the Wellcare Giveback (HMO-POS) plan, with a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Giveback (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Giveback (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance with prior authorization required, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance. 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, including diagnostic procedures and tests with a copay between $0 and $100, lab services with no copay, diagnostic radiological services with a copay up to $350, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $50 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback (HMO-POS) plan with no copay and no coinsurance. 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 by the Wellcare Giveback (HMO-POS) plan, but require prior authorization. For days 1-20 and 71-100, there is no copay, while days 21-70 have a $214 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the Wellcare Giveback (HMO-POS) plan. Specifically, acupuncture, over-the-counter items, meal benefits, 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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