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Wellcare Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 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 Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2026 to people living in Select counties in New Jersey. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Simple (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 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 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.
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 Simple (HMO-POS) prescription drug plan features an annual drug deductible of $615. Beneficiaries can save significantly on Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) medications, which feature no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies are also available but carry low copays starting at $5 for a one-month supply of generic drugs. For brand-name and specialty medications, costs transition to a coinsurance model. Tier 3 (Preferred Brand) and Tier 5 (Specialty) drugs require a 25% coinsurance, while Tier 4 (Non-Preferred) drugs require a 37% to 39% coinsurance depending on your choice of pharmacy. Utilizing preferred pharmacies and preferred mail-order services helps secure the lowest out-of-pocket costs for your prescriptions.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers affordable essential medical coverage featuring no copay and no coinsurance for primary care visits, annual physical exams, and home health services. For specialist visits, members pay a $55 copay, while emergency care incurs a $115 copay that is waived if admitted within 24 hours. Inpatient hospital stays require a $375 daily copay for the first seven days, followed by no copay for days eight through 90. Preventive dental services like exams and cleanings are covered with no copay, although routine vision exams, routine hearing exams, and hearing aids are not covered. Skilled nursing facility stays feature no copay for days 1 through 20, while durable medical equipment and dialysis services require a 20% coinsurance. Additionally, Medicare Part B insulin requires a $35 copay, while other Part B drugs are subject to a 0% to 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $375 daily copay for days 1 through 7 and no copay for days 8 through 90, while psychiatric stays incur a $2,075 copay per stay; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Wellcare Simple (HMO-POS) include outpatient hospital care with no copay and a 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 cost a $25 copay with no coinsurance, and outpatient blood services are provided with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple (HMO-POS) with a $105.00 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $305.00 copay and no coinsurance per trip, requiring 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 Simple (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $25 copay, both featuring no coinsurance and copays waived 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 Simple (HMO-POS) covers primary care visits with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Other covered services, including physical therapy, mental health, and telehealth, feature copays ranging from $0 to $55 with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) partially covers preventive services, offering annual physical exams, fitness benefits, alternative therapies, remote access technologies, and select screenings with no copay and no coinsurance. While kidney disease education is covered with no copay and a 20% coinsurance, several sub-services including health education, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
Wellcare Simple (HMO-POS) hearing services cover diagnostic exams with a $55 copay and no coinsurance, with no deductible and prior authorization required. Some services are covered, but routine hearing exams, fitting evaluations, OTC hearing aids, and all prescription hearing aids are not covered.
Vision Services See details
Vision services under Wellcare Simple (HMO-POS) are structured so that some services are covered with no deductible, no coinsurance, and copays ranging from no copay to $55. However, key sub-services including routine eye exams, contact lenses, and eyeglasses are not covered.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), offering Medicare-covered dental services for a $55 copay and no coinsurance, and preventive services like exams and cleanings with no copay and no coinsurance. While adjunctive general services are covered with no copay and no coinsurance, this plan does not cover restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, or orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple (HMO-POS) with no copay, though prior authorization is required. Medicare Part B insulin drugs under this benefit require a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs are subject to a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellcare Simple (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a copay ranging from $0 to $75. Covered radiological services require prior authorization and include diagnostic radiology with a 30% coinsurance and no copay, therapeutic radiology with a 20% coinsurance and a copay, and outpatient X-rays with a $50 copay and coinsurance.
Home Health Services See details
Wellcare Simple (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Wellcare Simple (HMO-POS) with no coinsurance. While some services are covered, others are not covered in practice, including cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $40 copay), pulmonary rehabilitation (with a $25 copay), and supervised exercise therapy for symptomatic peripheral artery disease (with a $20 copay).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Simple (HMO-POS) with no coinsurance, featuring no copay for days 1 through 20 and days 71 through 100, and a $218 daily copay for days 21 through 70. Prior authorization is required, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, offering acupuncture with no copay and no coinsurance for up to 24 treatments per year, though prior authorization is required. Over-the-counter (OTC) items, meal benefits, and other additional services are not covered under this plan.
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