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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 2025, 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 3.5 out of 5 stars in 2025.
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 $420.00 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) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay the following costs for drugs depending on the drug tier and pharmacy used. For preferred generic drugs, you will have no copay at preferred and mail-order pharmacies, and a $10 copay at standard pharmacies. The plan has no copay for specialty tier drugs. Other drugs have coinsurance costs ranging from 25% to 50%.
Additional Benefits
The Wellcare Simple (HMO) plan offers a range of benefits with varying costs. Hospital stays have copays, with outpatient services copays ranging from $0-$200. This plan also provides coverage for primary care, vision, and dental services with no copay in many cases, as well as hearing services. Additional benefits include coverage for ambulance and transportation services, emergency services, home health services, and skilled nursing facilities, each with its own cost structure.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $175 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you will pay a $150 copay for days 1-8, and no copay for days 9-90. Additional days for Inpatient Hospital-Acute has no copay for days 91-100. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $200, Observation Services have a copay between $140 and $200, ASC services have a $50 copay, and both individual and group sessions for outpatient substance abuse have a $40 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple (HMO) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellcare Simple (HMO) plan. Ground and air ambulance services have a $200 copay, and transportation services to a plan-approved health-related location have a $0 copay for up to 36 one-way trips per year using rideshare, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgent Services, and Worldwide Emergency Coverage all have a $140 copay, while Urgent Services have a $25 copay, with no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Occupational therapy, physician specialist services, and physical therapy and speech-language pathology services each have a $15 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions. Additional telehealth benefits have a copay between $0 and $40, and opioid treatment program services have a $15 copay.
Preventive Services See details
The Wellcare Simple (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like Fitness Benefit, Alternative Therapies, and Remote Access Technologies have a copay, while Kidney Disease Education Services have a 20% coinsurance. Other services like Health Education and In-Home Safety Assessment are not covered.
Hearing Services See details
Hearing services for the Wellcare Simple (HMO) plan include hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, and have a maximum plan benefit coverage of $1,000 per year.
Vision Services See details
Vision services include eye exams, with a copay of $0-$15, and eyewear, with a copay of $0. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all have no copay. Eyewear has a combined maximum benefit of $400 per year.
Dental Services See details
The Wellcare Simple (HMO) plan covers dental services, including Medicare dental services with a $15 copay, and other dental services like oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatment, other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery, and implant services, all with a $0 copay. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO) plan, with a doctor referral required. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $30, lab services with no copay, diagnostic radiological services with a copay up to $150, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $50 copay. All services require a doctor's referral and prior authorization.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a doctor referral, but specific services like Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. This plan does not specify any copay or coinsurance information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple (HMO) plan, requiring prior authorization and a doctor's referral. For days 1-20 and 41-100, there is no copay, but for days 21-40, the copay is $214.00. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Simple (HMO) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $205 every three months. The plan also covers meal benefits with no copay, but a doctor's referral is required. Acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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