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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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $700.00 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 $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying costs based on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 18% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0.00.
Additional Benefits
The Wellcare Simple (HMO) plan offers a wide array of benefits with varying costs. Inpatient hospital stays have no copay, and outpatient services can range from no copay to a $150 copay. The plan also covers ambulance services with a $75 copay, emergency services with a $140 copay, and primary care services, preventive services, hearing, vision, and dental services with no copay. This plan also includes additional benefits such as home health services with no copay, prescription hearing aids up to $750 per year, and over-the-counter items with a maximum benefit of $120 every three months. Additionally, the plan covers partial hospitalization with a $130 copay, and skilled nursing facility services with no copay for the first 20 days, $214 for days 21-30, and no copay for days 31-100.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with no copay for a Medicare-covered stay and no copay for additional days from days 91-999, as well as Inpatient Hospital Psychiatric with a $75 copay for days 1-5 and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $150, while observation services have a copay between $140 and $150. Ambulatory Surgical Center (ASC) Services and 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's referral. The copay for this benefit is $130.
Ambulance and Transportation Services See details
The Wellcare Simple (HMO) plan covers ambulance and transportation services. Ground and air ambulance services have a $75 copay, and transportation services to a plan-approved health-related location have no copay for up to 24 one-way trips per year, with coverage for rideshare services, bus/subway, and medical transport. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Wellcare Simple (HMO) plan, with a $140 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage are covered with a $140 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
For 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, 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 additional telehealth benefits have no copay. Chiropractic services, occupational therapy services, mental health specialty services, other health care professional services, psychiatric services, and opioid treatment program services have a $0 copay.
Preventive Services See details
The Wellcare Simple (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Alternative Therapies, and Remote Access Technologies with no copay, and a 20% coinsurance for Kidney Disease Education Services. Other services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Wellcare Simple (HMO) covers hearing exams and routine hearing exams with no copay, and also covers Fitting/Evaluation for Hearing Aid with no copay. Prescription hearing aids are covered up to $750 per year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and 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. Eye exams and eyewear have no copay, and eyewear has a combined maximum plan benefit of $400 per year.
Dental Services See details
The Wellcare Simple (HMO) plan covers 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, Implant Services, Prosthodontics, fixed, and Oral and Maxillofacial Surgery with no copay. The plan does not cover Maxillofacial Prosthetics or Orthodontics, and has limitations on some services, such as a limit of 2 oral exams per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a doctor referral, and the coinsurance is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, Diabetic Equipment with varying cost sharing, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of up to $50.00, and Outpatient X-Ray Services have a $40.00 copay. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a doctor referral, but the plan does not cover the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD. There is a copay for the covered services, but the specific amount is not listed in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple (HMO) plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20, a $214 copay for days 21-30, and no copay for days 31-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under Other Services, 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. Over-the-Counter (OTC) Items are covered with no copay and a maximum benefit of $120 every three months. Meal Benefits are covered with no copay and require a doctor's referral.
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