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Wellcare Simple (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple (HMO) in 2025, please refer to our full plan details page.
Wellcare Simple (HMO) is a HMO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in FL. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Simple (HMO) 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).
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), 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 $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 $3800.00 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) plan has a $420 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. Specialty tier drugs have no copay, and other tiers have coinsurance costs ranging from 25% to 46%. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Simple (HMO) plan offers a range of benefits with varying cost-sharing. You'll have a $300 copay per day for inpatient hospital stays (days 1-7) and no copay for days 8-90. Outpatient services have copays ranging from $0-$250, and primary care visits have no copay. Preventive services, including an annual physical, are covered with no copay, as are routine hearing and vision exams. The plan also includes coverage for dental, hearing, and vision services, with some limits and copays. Additional benefits include coverage for ambulance, emergency, and home health services, as well as home infusion and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $300 per day for days 1-7 and no copay for days 8-90 for acute care, and a copay of $345 per day for days 1-7 and no copay for days 8-90 for psychiatric care. Additional days for inpatient hospital acute care have no copay for days 91-100, and Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the Wellcare Simple (HMO) plan. Outpatient hospital services have a copay between $0 and $250, observation services have a copay between $140 and $250, and Ambulatory Surgical Center (ASC) Services have a $50 copay. Individual and group sessions for outpatient substance abuse have a copay of $40, while outpatient blood services have no copay.
Partial Hospitalization See details
Wellcare Simple (HMO) covers partial hospitalization with a $90 copay. Prior authorization and a doctor referral are required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple (HMO) plan. Ground and air ambulance services have a $190 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 Simple (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services have a $15 copay; all three have no coinsurance. Worldwide Urgent Coverage has a $140 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services, including routine care, are covered with a $20 copay, and require a referral and prior authorization. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services are covered with a $20 copay, and require a referral and prior authorization. Mental Health Specialty Services, including individual and group sessions, are covered with a $40 copay, and require a referral and prior authorization. Other Health Care Professional and Psychiatric Services have a copay between $0 and $20, and require a referral and prior authorization. Additional Telehealth Benefits are covered with a copay between $0 and $40, and require a referral and prior authorization. Opioid Treatment Program Services are covered with a $20 copay, and require a referral and prior authorization.
Preventive Services See details
The Wellcare Simple (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Fitness Benefits, Alternative Therapies, and Remote Access Technologies, with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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.
Hearing Services See details
Wellcare Simple (HMO) covers hearing exams with a $20 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are covered with a $1,000 maximum benefit per year, but OTC hearing aids are not covered, and specific types of prescription hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with routine eye exams covered with no copay and one visit allowed per year. Eyewear benefits, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, but have a combined maximum plan benefit of $200 per year.
Dental Services See details
The Wellcare Simple (HMO) plan covers Medicare Dental Services with a $20 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery are covered with no copay, while orthodontics has a $1,000 maximum benefit. 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. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple (HMO) plan, and require a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Wellcare Simple (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medicare-covered Medical Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $30, and lab services with no copay. Diagnostic Radiological Services have a copay up to $200, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $75 copay.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple (HMO) 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 covered with a doctor referral, but the plan does not cover any specific cardiac rehabilitation services. There is a copay for cardiac and pulmonary rehabilitation services, but no other cost information is provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. You will have no copay for days 1-20 and days 51-100, but will have a $214 copay for days 21-50.
Other Services See details
The Wellcare Simple (HMO) plan covers Over-the-Counter (OTC) items with no copay, up to a maximum of $44 every three months. The plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services.
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