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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 $2600.00 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. Once the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies or through mail order. For standard generic drugs, you'll pay 25% coinsurance. Specialty tier drugs have no copay.
Additional Benefits
The Wellcare Simple (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services, and emergency care. You'll find no copays for many services, such as primary care, preventive services like annual physical exams and routine vision exams, home health services, and certain dental services. The plan also includes additional benefits like hearing and vision services, along with coverage for prescription hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric care, with a copay of $175 per day for days 1-7 and $125 for days 1-5, respectively, and no copay for subsequent days. Additional days for acute care are covered with no copay for days 91-100, but non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $250, Observation Services have a copay between $140 and $250, ASC services have a $50 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple (HMO) plan, but requires prior authorization and a doctor referral. The copay for this service is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $250 copay, and transportation services to a plan-approved health-related location have no copay, with up to 48 one-way trips per year via rideshare services, bus/subway, and medical transport.
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, while Urgently Needed Services have a $15 copay, and all three have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services, a $10 copay for Chiropractic Services, and a $10 copay for Occupational Therapy Services, which requires authorization and referral. Physician Specialist Services have a $10 copay, while Mental Health Specialty Services, including individual and group sessions, have a $40 copay. Other Health Care Professional services have a copay between $0 and $10. Psychiatric Services, including individual and group sessions, have a $40 copay, and Physical Therapy and Speech-Language Pathology Services have a $10 copay. Additional Telehealth Benefits have a copay between $0 and $40, and Opioid Treatment Program Services have a $10 copay.
Preventive Services See details
The Wellcare Simple (HMO) plan covers preventive services including an annual physical exam with no copay, and additional preventive services. Additional preventive services include Fitness Benefit, Alternative Therapies, and Remote Access Technologies, all with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services, including 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) offers hearing services, including hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but inner ear, outer ear, and over the ear hearing aids are not covered; OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $10, and routine eye exams are covered with no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay and a combined maximum plan benefit coverage of $300 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $10 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Orthodontic services are covered up to a maximum of $5,000 per year, while 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 under the Wellcare Simple (HMO) plan, with a doctor referral required. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while 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
The Wellcare Simple (HMO) plan covers diagnostic and radiological services, including 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 $150, and therapeutic radiological services have a 20% coinsurance, while outpatient X-ray services have a $40 copay.
Home Health Services See details
Home Health Services are covered by 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 specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. This plan does not specify the cost sharing, such as copays or coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Simple (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20 and 41-100, but there is a $214 copay for days 21-40. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items and a Meal Benefit. The Over-the-Counter (OTC) Items benefit has no copay, and the plan offers up to $170 every three months. The Meal Benefit has no copay and requires a doctor's referral. Acupuncture, 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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