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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 2026, 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 4 out of 5 stars in 2026.
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 $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 $3500.00 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) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs, you will pay no copay when using preferred retail pharmacies or preferred mail-order services. Standard pharmacies require small copayments for Tier 1 and Tier 2 drugs, starting at $5 for a one-month supply of preferred generics. For higher-tier medications under this plan, your cost-sharing is based on coinsurance rather than flat copayments. Tier 3 preferred brand drugs and Tier 5 specialty drugs carry a 25% coinsurance, while Tier 4 non-preferred drugs require a 34% coinsurance. These straightforward rates help you easily calculate your out-of-pocket costs for brand-name and specialty prescriptions.
Additional Benefits
The Wellcare Simple (HMO) plan offers affordable healthcare coverage with no copay for primary care visits, home health services, and annual preventive screenings. Inpatient hospital stays require a $200 copay for days one through seven and no copay for days eight through 90, with no coinsurance. Outpatient services also feature no coinsurance, with outpatient hospital copays ranging from no copay to $250. This plan provides robust dental, vision, and hearing benefits, including no copay for routine eye exams, up to $300 annually for eyewear, and no copay for preventive dental services up to a $5,000 annual limit. Prescription hearing aids are covered up to $1,000 per ear with no copay, and emergency care is available for a $150 copay that is waived if admitted within 24 hours. Additionally, over-the-counter items and chronic illness meals are covered with no copay and no coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $200 copay for days 1 through 7 and no copay for days 8 through 90 for acute and psychiatric stays. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Simple (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $250 for outpatient hospital services, $150 to $250 per stay for observation services, and $50 for ambulatory surgical center services. Outpatient substance abuse services require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under Wellcare Simple (HMO) with a $175.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Wellcare Simple (HMO) covers Medicare-approved ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. While transportation services are technically covered, trips to plan-approved or other health-related locations are not covered.
Emergency Services See details
Wellcare Simple (HMO) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $15 copay and no coinsurance, both of which waive the copay if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum limit with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, occupational therapy, and routine chiropractic care require a $10 copay and no coinsurance. Mental health, psychiatric, and physical therapy services are covered with copays ranging from $25 to $40 and no coinsurance, though podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO) provides preventive services with no copay and no coinsurance for annual physical exams, alternative therapies, fitness benefits, remote access technologies, and other screenings. Kidney disease education is covered with no copay but requires a 20% coinsurance and a referral. Additional preventive services are partially covered, as the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety devices, or counseling services.
Hearing Services See details
Wellcare Simple (HMO) provides partially covered hearing services, including Medicare-covered exams for a $10 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $1,000 per ear annually with no copay and no coinsurance, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO) provides vision services with no coinsurance and no deductible, though prior authorization is required. Routine eye exams are covered with no copay once per year, and eyewear including glasses and contacts is covered with no copay up to a $300 annual limit, though other eye exam services are not covered.
Dental Services See details
Wellcare Simple (HMO) offers partially covered dental services, featuring no copay and no coinsurance for preventive and select comprehensive care up to a $5,000 annual maximum. Medicare-covered dental services require a $10 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Simple (HMO) covers dialysis services with no copay and a 20% coinsurance, though a referral is required to receive care.
Medical Equipment See details
Wellcare Simple (HMO) medical equipment benefits cover 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 or inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO) covers diagnostic and radiological services, with lab services offered at no copay and diagnostic tests ranging from no copay up to a $30 copay with no coinsurance. Outpatient X-rays require a $40 copay, diagnostic radiology starts at no copay, and therapeutic radiology has a 20% coinsurance, with prior authorization and referrals required.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple (HMO) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO) covers Cardiac Rehabilitation Services with no coinsurance and a referral requirement, but some services are covered while standard cardiac rehabilitation ($50 copay), intensive cardiac rehabilitation ($65 copay), pulmonary rehabilitation ($40 copay), and supervised exercise therapy ($30 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 to 20 and days 41 to 100, a $218 daily copay for days 21 to 40, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Wellcare Simple (HMO) provides partial coverage for other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though meals require a referral. Acupuncture and other additional services are not covered under this plan.
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