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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 $2000.00 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 features an annual drug deductible of $615, but offers excellent savings on several medication tiers. You will pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using a preferred pharmacy or preferred mail order service. Standard pharmacies and mail order options are also available for these tiers with low, predictable copayments ranging from $5 to $30 depending on the supply. For higher-tier medications, costs are based on coinsurance during the initial coverage phase. Tier 3 preferred brands require a 20% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs range from 26% to 44% coinsurance. Specialty drugs under Tier 5 carry a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Wellcare Simple (HMO) plan offers comprehensive medical coverage with many essential services available with no copay and no coinsurance, including primary care, specialist visits, and preventive care. For hospital care, inpatient acute stays require a $50 daily copay for days one through five and no copay for remaining days, while emergency room visits have a $150 copay. Outpatient services are also affordable, featuring a $25 copay for ambulatory surgical centers and no copay for laboratory services. This plan also features valuable supplemental benefits, providing routine dental, vision, and hearing services with no copay and no coinsurance. Members receive a $200 annual eyewear allowance, up to $1,500 per ear for prescription hearing aids, and 24 free one-way transportation trips to approved locations. Durable medical equipment and dialysis services are also covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO) covers inpatient hospital care with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. For acute care, you pay a $50 copay per day for days 1 to 5 and no copay for days 6 to 100, while psychiatric care requires a $100 daily copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
Wellcare Simple (HMO) covers outpatient services with no coinsurance, offering outpatient hospital visits with copays ranging from no copay to $250, and ambulatory surgical center services for a $25 copay. Outpatient substance abuse services require a $40 copay per session, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Simple (HMO) plan with a $175.00 copay and no coinsurance. Both 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 $50 copay and no coinsurance, while transportation services are partially covered with no copay or coinsurance. Transportation benefits are limited to 24 one-way trips per year to plan-approved locations, and 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 partially covered up to a $50,000 limit 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) are generally covered with no copay and no coinsurance, including primary care physician, specialist, and therapy visits. However, podiatry and other chiropractic services are not covered, while mental health and psychiatric sessions require a $40 copay with no coinsurance.
Preventive Services See details
Wellcare Simple (HMO) covers Medicare-covered preventive services and annual physical exams with no copay and no coinsurance. Additional preventive benefits are partially covered, offering fitness programs and remote access with no copay and no coinsurance, while services like health education, weight management, and in-home safety assessments are not covered. Kidney disease education is covered with no copay and a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by Wellcare Simple (HMO) with no copays, no coinsurance, and no deductibles for routine exams, fitting evaluations, and up to two prescription hearing aids per year with a $1,500 maximum benefit per ear. Prior authorization is required, and 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) offers vision services with no copay and no coinsurance, covering one routine eye exam annually and providing a $200 yearly allowance for eyewear like contacts, lenses, and frames. Prior authorization is required for these benefits, and other eye exam services are not covered.
Dental Services See details
Wellcare Simple (HMO) offers partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive care, though prior authorization is required. Maxillofacial prosthetics and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Wellcare Simple (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs have a coinsurance of 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 a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts have a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO) covers diagnostic and radiological services, both of which require prior authorization and a referral. Diagnostic tests and procedures have no coinsurance and a $0 to $30 copay, lab services have no copay and no coinsurance, outpatient x-rays have coinsurance but no copay, and therapeutic radiological services require 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, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Simple (HMO) with no coinsurance and a required referral, though only some services are covered; standard cardiac rehabilitation ($50 copay), intensive cardiac rehabilitation ($65 copay), pulmonary rehabilitation ($40 copay), and supervised exercise therapy for peripheral artery disease ($30 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Simple (HMO) with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20 and days 41 through 100, but a $218 daily copay applies for days 21 through 40, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Wellcare Simple (HMO) other services are partially covered, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this benefit, and the meal benefit requires a referral.
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