A non-government entity
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 $3400.00 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:
Sign up for Wellcare Simple (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple (HMO) plan has a $420 deductible for prescription drugs. After the deductible, you will pay the following costs for your prescriptions. For preferred generic drugs, you will have no copay at preferred and mail-order pharmacies, and a $10 copay at standard pharmacies. For standard generic drugs, you will pay 25% coinsurance, for preferred brand drugs you will pay 48% coinsurance, and for non-preferred drugs you will pay 28% coinsurance. Specialty tier drugs have no copay. 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, including inpatient hospital stays with a $250 copay for days 1-7, and no copay for days 8-90. Outpatient services have varying copays, while emergency services have a $140 copay. The plan also covers primary care with no copay, and offers hearing, vision, and dental services with no or low copays. Additional benefits include coverage for ambulance services with a $200 copay, and transportation to health-related locations with no copay for up to 12 one-way trips per year. Preventive services, like annual physical exams, are covered with no copay. Diagnostic and radiological services have copays ranging from $0 to $250. This plan also covers home health services and skilled nursing facility stays with no or low copays, as well as over-the-counter items up to $115 every three months.
Inpatient Hospital See details
The Wellcare Simple (HMO) plan covers inpatient hospital stays with a copay of $250 for days 1-7 and no copay for days 8-90; additional days for inpatient hospital-acute have no copay for days 91-100. Non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $300, observation services with a copay between $140 and $300, and Ambulatory Surgical Center (ASC) services with a $150 copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple (HMO) plan, but requires prior authorization and a doctor's referral. The copay for this benefit is $130.
Ambulance and Transportation Services See details
The Wellcare Simple (HMO) plan covers ambulance services with a $200 copay for both ground and air ambulance services. Transportation services to plan-approved health-related locations are covered with no copay, up to 12 one-way trips per year, but transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Urgent Coverage, are covered under the Wellcare Simple (HMO) plan, with a $140 copay for Emergency Services and Worldwide Emergency Coverage, and a $25 copay for Urgently Needed Services. Worldwide Emergency Transportation is not covered.
Primary Care See details
Wellcare Simple (HMO) covers primary care physician services with no copay, and chiropractic services with a $20 copay. This plan also covers occupational therapy, physician specialist services, and physical therapy and speech-language pathology services, each with a $20 copay, as well as mental health and psychiatric specialty services with a $40 copay for individual and group sessions. Other Health Care Professional services have a copay between $0 and $20, and Opioid Treatment Program Services have a $20 copay. Additional Telehealth Benefits have a copay between $0 and $40.
Preventive Services See details
The Wellcare Simple (HMO) plan covers preventive services, including an annual physical exam with no copay. Other covered preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following the Welcome Visit, all with no copay. Kidney disease education services are covered with 20% coinsurance.
Hearing Services See details
Wellcare Simple (HMO) covers hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1000 per year with no copay for all types, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$20, and routine eye exams with no copay. Eyewear benefits, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and have a combined maximum benefit of $300 per year.
Dental Services See details
Dental Services are covered by the Wellcare Simple (HMO) plan. Medicare Dental Services have a $20 copay, while oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery have no copay. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Simple (HMO) plan, requiring prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while other Medicare Part B drugs, including Chemotherapy/Radiation drugs, have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO) plan, but a doctor referral is required. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $30, lab services with no copay, and all radiological services. Diagnostic radiological services have a copay up to $250, while therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have a copay of $50.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (HMO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a required doctor referral, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20 and days 41-100, and a $214 copay for days 21-40. Additional days beyond Medicare and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Simple (HMO) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit of $115 every three months. Meal benefits are covered with no copay, but require a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved