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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. Under this plan, you will pay no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options are also available for Tier 1 and Tier 2 drugs with copays ranging from $5 to $30. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 (Preferred Brand) drugs and Tier 5 (Specialty Tier) drugs both require a 25% coinsurance. Tier 4 (Non-Preferred) drugs incur a 37% coinsurance at preferred pharmacies and preferred mail order, which increases to 39% coinsurance at standard pharmacies and standard mail order.
Additional Benefits
The Wellcare Simple (HMO) plan offers comprehensive coverage with no copay and no coinsurance for primary care, specialist visits, physical therapy, and preventive services. Beneficiaries also enjoy no copays or coinsurance for routine dental care, annual eye exams with a $400 eyewear allowance, and hearing services including up to two prescription hearing aids. For urgent medical needs, emergency room visits require a $150 copay and urgent care visits carry a $10 copay, both with no coinsurance. For hospital care, inpatient acute stays require a $100 daily copay for the first 3 days, followed by no copay for days 4 through 100. Outpatient surgical services, home health care, and up to 24 one-way transportation trips are also covered with no copay and no coinsurance. However, specialized services such as dialysis, durable medical equipment, and therapeutic radiological treatments require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Simple (HMO) with no coinsurance, though prior authorization and referrals are required. Acute stays carry a $100 daily copay for days 1 to 3 with no copay for days 4 to 100, and psychiatric stays require a $100 daily copay for days 1 to 10 with no copay for days 11 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Simple (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with copays ranging from $0 to $200 and observation services from $150 to $200 per stay. Ambulatory surgical center services require a $25 copay, outpatient substance abuse sessions have a $30 copay, and outpatient blood services are available with no copay, all with no coinsurance.
Partial Hospitalization See details
Wellcare Simple (HMO) covers partial hospitalization benefits with a $175.00 copay and no coinsurance. Prior authorization and a referral are required to access these services.
Ambulance and Transportation Services See details
Wellcare Simple (HMO) covers emergency ground and air ambulance services with a $200 copay and no coinsurance, subject to prior authorization. The plan also covers up to 24 one-way transportation trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Simple (HMO) covers emergency services with a $150 copay and urgently needed services with a $10 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. 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
Primary care benefits under Wellcare Simple (HMO) feature no copays and no coinsurance for primary care, specialist, physical therapy, and occupational therapy visits. Chiropractic services are partially covered with no copay or coinsurance for up to 12 routine visits per year, though other chiropractic services and podiatry are not covered, while mental health and psychiatric sessions require a $30 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Wellcare Simple (HMO), offering an annual physical, fitness benefits, alternative therapies, remote access, and select screenings for no copay and no coinsurance, though kidney disease education requires a referral and has no copay with a 20% coinsurance. Not covered services include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling.
Hearing Services See details
Wellcare Simple (HMO) hearing services are partially covered with no copay and no coinsurance, though prior authorization is required for exams and prescription aids. While annual routine exams, fitting evaluations, and up to two prescription hearing aids (up to $1,000 per ear per year) are covered, OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO) provides partially covered vision services with no copay, no coinsurance, and no deductible, though prior authorization is required and other eye exam services are not covered. Covered benefits include one routine eye exam per year and a combined maximum of $400 per year for eyewear, including contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Wellcare Simple (HMO) partially covers dental services with no copay and no coinsurance for covered diagnostic, preventive, and comprehensive services. Maxillofacial prosthetics and orthodontics are not covered by this plan, and prior authorization is required for most services.
Home Infusion bundled Services See details
Wellcare Simple (HMO) covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization is required. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Simple (HMO) with no copay and a 20% coinsurance, though a referral is required to receive these services.
Medical Equipment See details
Wellcare Simple (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts require 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO) covers diagnostic and radiological services, requiring prior authorization and referrals for care. Diagnostic procedures feature no coinsurance and a $0 to $20 copay, lab services have no copay or coinsurance, and radiological services range from no copay for diagnostic imaging to a $40 copay for X-rays and a minimum 20% coinsurance for therapeutic treatments.
Home Health Services See details
Wellcare Simple (HMO) covers home health services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Simple (HMO) plan, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, 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 Medicare-covered limit 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, while acupuncture is not covered. The meal benefit requires a referral, and OTC items are eligible for reimbursement.
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