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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 generics and Tier 2 generics, you will pay no copay when using a preferred retail pharmacy or preferred mail-order service. Additionally, Tier 6 select care drugs are highly affordable, requiring no copay across all standard and preferred pharmacy and mail-order options. For higher-tier medications, Tier 3 preferred brands and Tier 5 specialty drugs both require a 25% coinsurance. Tier 4 non-preferred drugs carry a 34% coinsurance at preferred pharmacies and a 35% coinsurance at standard pharmacies. If you choose to use a standard pharmacy, copays for Tier 1 and Tier 2 generic drugs start at a low cost of $5 and $10, respectively.
Additional Benefits
The Wellcare Simple (HMO) plan offers affordable coverage for core medical needs, featuring no copay or coinsurance for primary care visits and preventive services. Specialist visits, physical therapy, and routine dental and hearing exams are highly accessible with a low $10 copay and no coinsurance. For more intensive care, inpatient hospital stays require a daily copay for the first five days with no coinsurance, while emergency room visits carry a flat $150 copay. This plan also includes valuable supplemental benefits like routine vision care with a $200 annual eyewear allowance and prescription hearing aid coverage up to $500 per ear. Additionally, members can take advantage of 24 free one-way trips to approved health locations, alongside home health services with no copay. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO) covers inpatient hospital services with no coinsurance, requiring a $175 daily copay for days 1 to 5 of acute stays and a $150 daily copay for days 1 to 5 of psychiatric stays, followed by no copay for subsequent covered days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, 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 a copay ranging from no copay to $300, and observation services with a $150 to $300 copay per stay. Ambulatory surgical center services require a $50 copay and no coinsurance, outpatient substance abuse sessions carry a $40 copay and no coinsurance, and blood services are covered with no copay and no 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 for this benefit.
Ambulance and Transportation Services See details
Wellcare Simple (HMO) covers ambulance services with a $200 copay and no coinsurance for both ground and air transport. The plan also covers 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
Wellcare Simple (HMO) covers emergency services with a $150 copay and urgently needed services with a $15 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially 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) provides primary care physician services with no copay and no coinsurance, while specialist, physical therapy, occupational therapy, and routine chiropractic services require a $10 copay and no coinsurance. Mental health and psychiatric sessions have a $40 copay and no coinsurance, but podiatry services are not covered.
Preventive Services See details
Preventive services under Wellcare Simple (HMO) are partially covered, offering annual physical exams, fitness benefits, alternative therapies, and remote access technologies with no copay and no coinsurance. Kidney disease education requires a referral and has no copay with a 20% coinsurance, while other services like glaucoma screenings require a referral but have no copay and no coinsurance. Several supplemental options, such as health education, weight management, and nutritional benefits, are not covered.
Hearing Services See details
Wellcare Simple (HMO) hearing services are partially covered, offering Medicare-covered exams for a $10 copay and routine exams or fittings with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO) vision services are partially covered, offering one annual routine eye exam and covered eyewear with no copay, no coinsurance, and no deductibles, though other eye exam services are not covered. Prior authorization is required, and there is a $200 annual maximum benefit for eyewear, including contact lenses and eyeglasses.
Dental Services See details
Wellcare Simple (HMO) partially covers dental services, providing Medicare-covered dental care with a $10.00 copay and no coinsurance, while preventive and comprehensive services are available with no copay and no coinsurance. However, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple (HMO) with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs carry a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a 0% to 20% coinsurance.
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
Wellcare Simple (HMO) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, 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), requiring referrals and prior authorization. Lab services and outpatient X-rays feature no copay, diagnostic tests have no coinsurance and a copay of $0 to $30, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellcare Simple (HMO) with no copay and no coinsurance. To access this benefit, both a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO) covers Cardiac Rehabilitation Services with a referral and no coinsurance; however, while some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, as additional days beyond the standard Medicare-covered limit are not covered. Prior authorization and referrals are required, with no copay for days 1 to 20 and 41 to 100, and a $218 copay for days 21 to 40.
Other Services See details
Wellcare Simple (HMO) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance, while acupuncture is not covered. The meal benefit requires a referral, and OTC items are provided via reimbursement.
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