A non-government entity
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 $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:
Sign up for Wellcare Simple (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple (HMO) plan has a $420 deductible for prescription drugs. Once you meet your deductible, you will pay the following costs. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. For standard generic drugs, you will pay 25% coinsurance, while preferred brand drugs have a 37-38% coinsurance. Non-preferred drugs have a 28% coinsurance, and specialty tier drugs have no copay. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Simple (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the service. Many services, like primary care visits, hearing exams, vision exams, and dental services, have no copay. Emergency, ambulance, and transportation services are covered, but have a copay. This plan also covers preventive services, home health services, and skilled nursing facilities with no or low copays. Diagnostic and radiological services, as well as medical equipment, have either a copay or coinsurance. Some services, such as cardiac rehabilitation and certain home care services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $50 copay for days 1-5, and no copay for days 6-90, with 10 additional days covered with no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you pay a $75 copay for days 1-5, and no copay for days 6-90, with additional days and non-Medicare covered stays not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $250, Observation Services with a copay between $140 and $250, Ambulatory Surgical Center (ASC) Services with a $25 copay, Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions, and Outpatient Blood Services with no copay. These services may require prior authorization and/or a doctor referral.
Partial Hospitalization See details
Wellcare Simple (HMO) covers partial hospitalization with a $130 copay, and requires both prior authorization and a doctor's referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple (HMO) plan, with a $250 copay for both ground and air ambulance services and no coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Simple (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services has a $10 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
Under the Wellcare Simple (HMO) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and other health care professional services have no copay, while mental health specialty services and psychiatric services have a $40 copay for individual and group sessions, and additional telehealth benefits have a $0-$40 copay.
Preventive Services See details
The Wellcare Simple (HMO) plan covers preventive services with no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Other preventive services are covered with a copay, while kidney disease education services have a 20% coinsurance. Some services, such as health education, in-home safety assessments, and personal emergency response systems, are not covered.
Hearing Services See details
Wellcare Simple (HMO) covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered under the Wellcare Simple (HMO) plan. Routine eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $600.00 every year.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery with no copay. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Simple (HMO) plan, with a $35 copay for Medicare Part B Insulin Drugs. The plan covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple (HMO) plan and require a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while durable medical equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $30, lab services with no copay, diagnostic radiological services with a copay up to $100, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $40 copay. All services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Simple (HMO) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A doctor's referral is required for services that are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple (HMO) plan with prior authorization and a doctor's referral. There is no copay for days 1-20 and days 31-100, but there is a $214 copay for days 21-30; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services for the Wellcare Simple (HMO) plan covers over-the-counter (OTC) items and meal benefits, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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. OTC items have no copay, and meal benefits also have no copay.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved