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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 $2900.00 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 prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, you will pay no copay when using preferred pharmacies or preferred mail-order services. If you choose standard pharmacies, Tier 1 and Tier 2 drugs require low copays starting at $5 and $10 respectively, while Tier 6 drugs remain at no copay. For higher-tier medications, cost-sharing transitions to coinsurance, with Tier 3 preferred brands and Tier 5 specialty drugs both carrying a 25% coinsurance. Tier 4 non-preferred drugs incur a 37% coinsurance at preferred locations and a 38% coinsurance at standard pharmacies. Specialty tier medications are limited to a one-month supply at a 25% coinsurance rate at both preferred and standard pharmacies.
Additional Benefits
Wellcare Simple (HMO) features robust coverage with no coinsurance for many core services, including inpatient hospital stays which require a $175 daily copay for the first seven days and no copay thereafter. Primary care visits, home health care, and cardiac rehabilitation are available with no copay, while specialist visits and urgent care require low copays of $15 and $25 respectively. Emergency room visits carry a $150 copay, and outpatient hospital services range from no copay up to a $200 copay. The plan also provides valuable supplemental benefits, offering preventive and comprehensive dental care, routine vision exams, and eyewear up to a $400 limit with no copays. Routine hearing exams and hearing aids up to $1,000 per ear are also covered with no copay, while Medicare-covered hearing exams require a $15 copay. For specialized medical needs, durable medical equipment and dialysis services require a 20% coinsurance with no copay, and Medicare Part B insulin is capped at a $35 copay.
Inpatient Hospital See details
Wellcare Simple (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $175 daily copay for days 1 through 7 and no copay for days 8 through 90 for both acute and psychiatric stays. While acute stays include 10 additional coverage days at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO) covers outpatient hospital services with a $0 to $200 copay, observation services with a $150 to $200 copay per stay, and ambulatory surgical center services with a $50 copay, all with no coinsurance. Outpatient substance abuse services have a $40 copay and no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple (HMO) with a $175 copay and no coinsurance. This benefit requires both a referral and prior authorization.
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 with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but 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 $25 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $150 copay and no coinsurance, though 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 specialists, physical therapy, and occupational therapy require a $15 copay and no coinsurance. Mental health and psychiatric services have a $40 copay and no coinsurance, chiropractic care is partially covered with other chiropractic services excluded, and podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO) offers partially covered preventive services with no copay and no coinsurance for annual physicals, fitness benefits, alternative therapies, and routine screenings, while kidney disease education requires a 20% coinsurance and no copay. Several supplemental services are not covered, including health education, personal emergency response systems, weight management, and in-home safety assessments.
Hearing Services See details
Wellcare Simple (HMO) partially covers hearing services with no coinsurance, requiring a $15 copay for Medicare-covered exams and no copay for annual routine exams, fitting evaluations, and prescription hearing aids up to $1,000 per ear annually. However, OTC hearing aids and 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 because other eye exam services are not covered. Covered eye exams have a copay of $0 to $15 and no coinsurance, while routine exams and eyewear—including contacts and eyeglasses—have no copay and no coinsurance, with eyewear limited to a $400 annual maximum.
Dental Services See details
Wellcare Simple (HMO) partially covers dental services, offering Medicare-covered dental care with a $15 copay and no coinsurance, alongside preventive and comprehensive services with no copay and no coinsurance. Prior authorization is required for most services, and orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO) plan with no copay and a 20% coinsurance. A referral is required to access these covered services.
Medical Equipment See details
Wellcare Simple (HMO) covers medical equipment, including 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 and no copay, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO) covers diagnostic and radiological services, with prior authorization and referrals required. Outpatient diagnostic tests have no coinsurance and a copay of $0 to $30, while lab services and diagnostic radiology have no copay. Outpatient X-rays require a $50 copay with coinsurance, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Wellcare Simple (HMO) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO) covers Cardiac Rehabilitation Services with no copay, no coinsurance, and a referral requirement. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO) covers Skilled Nursing Facility (SNF) services 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 benefit are not covered.
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. A referral is required to receive the meal benefit, and OTC items are covered through reimbursement.
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