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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 $3000.00 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 plan features an annual drug deductible of $615. You can enjoy no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred retail pharmacy or preferred mail-order services. Additionally, Tier 6 select care drugs have no copay regardless of whether you use preferred or standard pharmacies and mail-order options. For other medication tiers, the plan transitions to coinsurance, requiring 25% coinsurance for Tier 3 preferred brands and Tier 5 specialty drugs. Tier 4 non-preferred drugs incur a 33% coinsurance across all pharmacy types. If you choose to fill Tier 1 or Tier 2 prescriptions at a standard pharmacy, copays range from $5 to $30 depending on the drug tier and supply fill.
Additional Benefits
The Wellcare Simple (HMO) plan offers affordable healthcare coverage with no copay for primary care visits, annual physicals, and routine preventive screenings. Specialist visits require a low $15 copay, while inpatient hospital stays feature no coinsurance and a $175 daily copay for the first seven days. Emergency room visits carry a $150 copay and urgent care is just $10, with both fees waived upon hospital admission. In addition to medical care, the plan provides excellent supplemental benefits including routine dental, vision, and hearing exams with no copay, alongside a $3,000 annual dental limit. Members also benefit from no-copay home health services and up to 12 free one-way transportation trips per year to approved health locations. Durable medical equipment and dialysis services are covered with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization and referrals for both acute and psychiatric stays. Acute stays require a $175 daily copay for days 1 through 7 and no copay for days 8 through 100, while psychiatric stays require a $150 daily copay for days 1 through 8 and no copay for days 9 through 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Simple (HMO) with no coinsurance, featuring copays of $0 to $300 for outpatient hospital services and $150 to $300 per stay for observation services. Ambulatory surgical center services require a $150 copay and no coinsurance, outpatient substance abuse sessions carry a $40 copay, and outpatient blood services are provided with no copay or coinsurance.
Partial Hospitalization See details
Wellcare Simple (HMO) covers partial hospitalization services 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 ground and air ambulance services with a $275 copay and no coinsurance per trip. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is 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 $10 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are covered up to a $50,000 limit with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, occupational therapy, and opioid treatment require a $15 copay and no coinsurance. Physical therapy has a $25 copay, mental health and psychiatric services carry a $40 copay, and chiropractic care is partially covered, all with no coinsurance, though podiatry is not covered.
Preventive Services See details
Wellcare Simple (HMO) covers key preventive services, including annual physical exams and Medicare-covered screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering fitness programs, alternative therapies, and remote access technologies with no copay, while kidney disease education requires no copay but has a 20% coinsurance.
Hearing Services See details
Wellcare Simple (HMO) covers Medicare-covered hearing exams with a $15 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered up to $500 per ear annually with no copay and no coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO) vision services are partially covered, offering eye exams with a $0 to $15 copay and eyewear with no copay, alongside no coinsurance or deductibles. Covered benefits include one routine eye exam annually and up to $200 per year for eyewear, though prior authorization is required and other eye exam services are not covered.
Dental Services See details
Wellcare Simple (HMO) dental services are partially covered, offering preventive and comprehensive care with no copay and no coinsurance up to a $3,000 annual limit, while Medicare-covered dental services require a $15 copay and no coinsurance. Prior authorization is required for most services, and 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. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance of 0% to 20%.
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) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay from specified manufacturers, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO) with no coinsurance for diagnostic services, no copay for lab services, and a $0 to $30 copay for diagnostic procedures. Outpatient X-rays require a $15 copay, diagnostic radiological services have a $0 minimum copay, and therapeutic radiological services carry a minimum 20% coinsurance, with prior authorization and referrals required.
Home Health Services See details
Wellcare Simple (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under Wellcare Simple (HMO) with no coinsurance and no copay, though only some services are covered in practice. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Simple (HMO) with no coinsurance, featuring no copay for days 1 to 20 and 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 100-day Medicare benefit period are not covered.
Other Services See details
Wellcare Simple (HMO) partially covers 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 is not covered under this benefit.
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