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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 $1000.00 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. Under this plan, you will enjoy 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 charge a low copay starting at $5 for Tier 1 and $10 for Tier 2 drugs, while Tier 6 drugs feature no copay across all network pharmacies. Brand-name and specialty medications are covered under coinsurance rather than flat copays. Tier 3 preferred brands require a 17% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs carry a 25% coinsurance at preferred locations and 50% at standard locations. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply at both standard and preferred pharmacies.
Additional Benefits
The Wellcare Simple (HMO) plan offers robust coverage with no copays or coinsurance for primary care, specialist visits, preventive services, and unlimited acute inpatient hospital stays. For outpatient services and emergency care, members can expect low to moderate copays, such as a $150 copay for emergency room visits and no copays for ambulatory surgical center services. Additionally, essential diagnostic tests and home health services are covered with no copay or coinsurance. This plan also provides strong supplemental benefits, including dental, vision, and hearing care with no copays, no coinsurance, and no deductibles for routine services. Members benefit from a $300 annual eyewear allowance, up to $750 per ear for prescription hearing aids, and up to 24 free one-way transportation trips to approved locations. Specialized services like dialysis and durable medical equipment require no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO) partially covers inpatient hospital services with no coinsurance, offering acute hospital stays with no copay for unlimited days, while psychiatric stays require a $100 daily copay for days 1 to 5 and no copay for days 6 to 90. Prior authorization and referrals are required, and upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO) outpatient services are covered with no coinsurance, featuring no copays for ambulatory surgical center services, outpatient substance abuse sessions, and outpatient blood services. Medicare-covered outpatient hospital services require a copay ranging from $0 to $150, while outpatient observation services carry a $150 copay per stay.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple (HMO) with a $175.00 copay and no coinsurance. This benefit requires both prior authorization and a referral.
Ambulance and Transportation Services See details
Wellcare Simple (HMO) covers ground and air ambulance services with a $75 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, 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 no coinsurance, with the copay waived if admitted within 24 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO) primary care benefits are partially covered, offering no copay and no coinsurance for primary care, specialist, mental health, and therapy services. Under this plan, podiatry services and other chiropractic services are not covered.
Preventive Services See details
Wellcare Simple (HMO) offers partially covered preventive services, including annual physicals, fitness benefits, and remote access technologies with no copay and no coinsurance, though sub-services like health education, in-home safety assessments, and nutritional/dietary benefits are not covered. Kidney disease education is covered with no copay and 20% coinsurance, while other services like diabetes self-management and glaucoma screenings require a referral but have no copay and no coinsurance.
Hearing Services See details
Wellcare Simple (HMO) partially covers hearing services, offering Medicare-covered exams, annual routine exams, and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered up to $750 per ear annually with no copay or coinsurance, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Simple (HMO) partially covers vision services with no copay, no coinsurance, and no deductible for covered routine eye exams and eyewear, although prior authorization is required. The plan includes one routine eye exam per year and a $300 annual allowance for eyewear, but other eye exam services are not covered.
Dental Services See details
Wellcare Simple (HMO) dental services are partially covered, offering preventive and comprehensive care with no copay and no coinsurance, although prior authorization is required for most services. 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 is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance.
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 medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO) with no copay or coinsurance for diagnostic tests, procedures, and lab services. Diagnostic radiological services have no copay, while outpatient X-rays require a $15 copay and therapeutic radiological services carry a 20% coinsurance. Prior authorization and referrals are required for these services.
Home Health Services See details
Wellcare Simple (HMO) covers home health services 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 coinsurance, though a referral is required and only some services are covered. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellcare Simple (HMO) with no coinsurance, requiring prior authorization and a referral but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 31 through 100, but a $218 daily copay applies for days 21 through 30, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO) provides partial coverage for other services, which includes over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered under this plan, and a referral is required to receive the covered meal benefits.
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