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Wellcare Giveback (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback (HMO) in 2026, please refer to our full plan details page.
Wellcare Giveback (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 Giveback (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 Giveback (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 Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $157.00. You must continue to pay paying your reduced 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 $5000.00 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 Giveback (HMO) plan features an annual drug deductible of $615. For Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs), members can enjoy no copay when using preferred pharmacies or preferred mail-order services. Standard pharmacies charge a low copay for these tiers, ranging from $5 to $10 for a one-month supply of Tier 1 and Tier 2 drugs, while Tier 6 drugs have no copay across all pharmacies. For higher-tier medications, costs are based on coinsurance rather than set copays. Tier 3 (Preferred Brand) drugs require a 20% coinsurance at preferred pharmacies and 22% at standard pharmacies, while Tier 4 (Non-Preferred) drugs range from 26% to 40% coinsurance. Specialty drugs in Tier 5 carry a flat 25% coinsurance for a one-month supply at both preferred and standard locations.
Additional Benefits
The Wellcare Giveback (HMO) plan offers affordable coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For hospital stays, members pay a $325 daily copay for days one through eight of acute inpatient care with no coinsurance, while emergency room visits carry a $130 copay. Specialist visits, physical therapy, and urgent care are also highly accessible with a $20 copay and no coinsurance. This plan also includes valuable supplemental benefits, providing routine dental, vision, and hearing exams with no copay and no coinsurance. Members receive a $200 annual eyewear allowance and up to a $750 annual maximum per ear for prescription hearing aids with no copay. Additionally, diagnostic lab work and diabetic supplies are covered with no copay, while durable medical equipment carries a 20% coinsurance.
Inpatient Hospital See details
Wellcare Giveback (HMO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $325 daily copay for days 1 to 8 (no copay for days 9 to 90) for acute stays, and a $2,000 copay per admission for psychiatric stays. Prior authorization and referrals are required, and non-covered sub-services include additional days, non-Medicare-covered stays, and acute room upgrades.
Outpatient Services See details
Outpatient services are covered by Wellcare Giveback (HMO) with no coinsurance, featuring a $0 to $250 copay for outpatient hospital services and a $130 to $250 copay per stay for observation services. Ambulatory surgical center services require a $50 copay and no coinsurance, outpatient substance abuse sessions carry a $40 copay and no coinsurance, and outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare Giveback (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization and a referral are required to receive this covered care.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance, subject to prior authorization, while transportation services are not covered.
Emergency Services See details
Wellcare Giveback (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $20 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under the Wellcare Giveback (HMO) plan feature primary care physician visits with no copay and no coinsurance, while specialist, occupational therapy, and physical therapy visits require a $20 copay and no coinsurance. Mental health and psychiatric services have a $40 copay with no coinsurance, routine chiropractic care is partially covered at a $15 copay with no coinsurance, and podiatry services are not covered.
Preventive Services See details
Wellcare Giveback (HMO) covers preventive services, including annual physical exams, fitness benefits, and alternative therapies, with no copay and no coinsurance. Kidney disease education is covered with no copay but has a 20% coinsurance and requires a referral, while several supplemental benefits such as health education and weight management programs are not covered.
Hearing Services See details
Hearing services covered by Wellcare Giveback (HMO) include Medicare-covered exams for a $20 copay and no coinsurance, as well as routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $750 annual maximum per ear, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Giveback (HMO) partially covers vision services with no deductibles and no coinsurance, though prior authorization is required. Routine eye exams and eyewear have no copay, featuring a $200 annual eyewear allowance, while other Medicare-covered exams have up to a $20 copay and other eye exam services are not covered.
Dental Services See details
Wellcare Giveback (HMO) partially covers dental services, offering preventive care with no copay and no coinsurance, and Medicare-covered dental with a $20 copay and no coinsurance. Comprehensive dental benefits require no copay and a 20% coinsurance up to a $2,000 annual maximum, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Wellcare Giveback (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Giveback (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though a referral is required to receive care.
Medical Equipment See details
Wellcare Giveback (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance, while diabetic therapeutic shoes or inserts require a 20% coinsurance and no copay, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Giveback (HMO) covers diagnostic and radiological services, requiring referrals and prior authorizations for both. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic tests with a $0 to $40 copay, while radiological services include a $40 copay for X-rays, diagnostic radiology starting at no copay, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellcare Giveback (HMO) with no copay and no coinsurance. This benefit requires both a referral and prior authorization before services can be received.
Cardiac Rehabilitation Services See details
Wellcare Giveback (HMO) covers Cardiac Rehabilitation Services with no coinsurance and a required referral, although only some services are covered in practice. Standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation (with a $50 copay), pulmonary rehabilitation (with a $35 copay), and SET for PAD services (with a $25 copay) are not covered under this benefit.
Skilled Nursing Facility (SNF) See details
Wellcare Giveback (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no prior three-day inpatient hospital stay, though prior authorization and referrals are required. There is no copay for days 1 through 20 and days 51 through 100, a $218 daily copay applies for days 21 through 50, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Wellcare Giveback (HMO) indicates that some services are covered under the Other Services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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