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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 $2500.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, members pay no copay at preferred pharmacies or through preferred mail order, while Tier 6 (Select Care Drugs) has no copay across all pharmacy options. Standard pharmacies charge low copays starting at $5 for Tier 1 and $10 for Tier 2 drugs. For higher-tier medications, cost sharing is based on a percentage of the drug cost rather than flat copays. Tier 3 (Preferred Brand) and Tier 5 (Specialty Tier) drugs require a 25% coinsurance, while Tier 4 (Non-Preferred Drug) medications carry a 31% coinsurance. These coinsurance rates apply across both preferred and standard pharmacy networks during the initial coverage phase.
Additional Benefits
The Wellcare Simple (HMO) plan offers robust healthcare coverage with many services requiring no copay and no coinsurance, including inpatient acute hospital stays, primary care visits, and annual physicals. For specialist visits, routine chiropractic care, and physical therapy, members will pay low copays ranging from $15 to $20. Emergency room visits carry a $150 copay, which is waived if admitted, while urgent care and home health services require no copay. Essential benefits like routine dental, routine vision exams, and hearing exams are also available with no copay and no coinsurance. The plan features valuable allowances, including up to $400 annually for eyewear and up to $1,000 per ear for prescription hearing aids. Additionally, members can access over-the-counter items and up to 24 one-way routine transportation trips per year at no copay.
Inpatient Hospital See details
Wellcare Simple (HMO) covers inpatient acute hospital stays with no copay, no coinsurance, and up to 10 additional days, while inpatient psychiatric stays are covered with no coinsurance and a $75 daily copay for days 1 through 7 (no copay for days 8 through 90). Prior authorization and referrals are required for these benefits, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $250 copay and observation services with a $150 to $250 copay per stay. Ambulatory surgical center services require a $50 copay and no coinsurance, while outpatient substance abuse services have a $40 copay and blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Wellcare Simple (HMO) covers partial hospitalization services with a $175.00 copay and no coinsurance. This benefit requires both prior authorization and a referral.
Ambulance and Transportation Services See details
Wellcare Simple (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Wellcare Simple (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services have no copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum benefit with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO) features primary care and occupational therapy services with no copay and no coinsurance, while specialist visits require a $15 copay and no coinsurance. Chiropractic services are partially covered, offering routine care for a $15 copay and no coinsurance, though other chiropractic services and podiatry services are not covered. Mental health and psychiatric services carry a $40 copay with no coinsurance, and physical therapy costs a $20 copay with no coinsurance.
Preventive Services See details
Preventive services under Wellcare Simple (HMO) are covered with no copay and no coinsurance for annual physicals, fitness benefits, and remote access technologies, though additional preventive services are only partially covered with options like health education and in-home safety assessments excluded. Kidney disease education is covered with no copay and a 20% coinsurance, subject to a referral. Other preventive screenings, including glaucoma and diabetes self-management training, are covered with no copay and no coinsurance, but also require a referral.
Hearing Services See details
Wellcare Simple (HMO) hearing services are partially covered, offering Medicare-covered exams for a $15 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered each year with no copay and no coinsurance up to a $1,000 limit per ear, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services under Wellcare Simple (HMO) are partially covered, featuring no coinsurance and no deductibles for all services. Routine eye exams are covered with no copay (limited to one yearly, with other eye exam services not covered), and eyewear benefits—including contacts, frames, and lenses—are covered with no copay up to a $400 annual maximum.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO), featuring a $15 copay and no coinsurance for Medicare-covered dental services, and no copay or coinsurance for most preventive and comprehensive dental care. Prior authorization is required for most of these services, and maxillofacial prosthetics as well as orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO) covers home infusion bundled services with no copay, while associated Medicare Part B insulin carries a $35 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and select drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellcare Simple (HMO) covers dialysis services with no copay and a 20% coinsurance, although a referral is required to receive these services.
Medical Equipment See details
Medical equipment is covered under Wellcare Simple (HMO), with durable medical equipment, prosthetics, and medical supplies requiring no copay and a 20% coinsurance. Diabetic supplies feature no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO) covers diagnostic and radiological services, requiring referrals and prior authorization for all services. Under this plan, diagnostic lab services and diagnostic radiology have no copay, diagnostic tests range from a $0 to $30 copay with no coinsurance, outpatient X-rays have a $50 copay, and therapeutic radiology requires a 20% coinsurance.
Home Health Services See details
Home health services are covered by Wellcare Simple (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered under Wellcare Simple (HMO) with no coinsurance and a referral requirement; while some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and days 41 to 100, and a $218 daily copay for days 21 to 40. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under Wellcare Simple (HMO) are partially covered, featuring over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered, and the meal benefit requires a referral.
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