A non-government entity
Wellcare Patriot Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Patriot Simple (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Patriot Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Patriot Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in GA. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Patriot Simple (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Patriot Simple (HMO-POS).
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 Patriot Simple (HMO-POS), 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 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 Patriot Simple (HMO-POS)
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
Prescription drugs are not covered by Wellcare Patriot Simple (HMO-POS).
Additional Benefits
The Wellcare Patriot Simple (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care, specialist visits, and preventive services. For hospital care, members pay a $350 copay for the first five days of inpatient acute stays, while outpatient hospital services range from no copay to a $300 copay. Emergency room visits require a $150 copay, which is waived if you are admitted, and urgent care is available with a $35 copay. This plan also includes valuable supplemental benefits with no copay for routine dental, vision, and hearing services, including a $5,000 annual dental limit and a $400 eyewear allowance. Additionally, members can access up to 24 one-way transportation trips per year and over-the-counter items with no copay. Skilled nursing facility care is also highly affordable, requiring no copay for the first 20 days of your stay.
Inpatient Hospital See details
Wellcare Patriot Simple (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 copay for days 1 to 5 of acute stays and a $325 copay for days 1 to 4 of psychiatric stays, with no copay for subsequent days up to day 90. Prior authorization is required, and upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Patriot Simple (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $150 to $300 copay per stay for observation services. Ambulatory surgical center services require a $250 copay and no coinsurance, while outpatient substance abuse and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Patriot Simple (HMO-POS) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Patriot Simple (HMO-POS), featuring a $200 copay and no coinsurance for ground and air ambulance services. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Wellcare Patriot Simple (HMO-POS) covers emergency services with a $150 copay and no coinsurance, and urgent care with a $35 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 maximum with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Patriot Simple (HMO-POS) covers primary care, specialist, mental health, and physical therapy services with no copay and no coinsurance, while telehealth benefits are offered with a copay of $0 to $35 and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Wellcare Patriot Simple (HMO-POS) offers partially covered preventive services, featuring no copay and no coinsurance for annual physicals, fitness benefits, alternative therapies, and various screenings. While kidney disease education requires a 20% coinsurance and no copay, several supplemental benefits such as health education, weight management, and nutritional training are not covered.
Hearing Services See details
Wellcare Patriot Simple (HMO-POS) offers hearing services with no copay, no coinsurance, and no deductible, though prior authorization is required. Routine exams and fittings are covered, while prescription hearing aids are partially covered up to $1,000 per ear annually, excluding inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids.
Vision Services See details
Vision Services are partially covered by Wellcare Patriot Simple (HMO-POS) with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. Covered benefits include one routine eye exam per year and up to a $400 annual combined maximum for contact lenses, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Wellcare Patriot Simple (HMO-POS) with no copay and no coinsurance for covered preventive and comprehensive care, up to a $5,000 annual limit. While many services like cleanings, x-rays, and restorative treatments are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Patriot Simple (HMO-POS) covers home infusion bundled services with no copay, although prior authorization and step therapy may be required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance between 0% and 20%.
Dialysis Services See details
Wellcare Patriot Simple (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Patriot Simple (HMO-POS) with no copays and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Patriot Simple (HMO-POS) with prior authorization required. Outpatient diagnostic procedures and tests have a copay ranging from $0 to $20 with no coinsurance, while lab services have no copay and no coinsurance. Diagnostic radiological services carry a $0 minimum copay, outpatient X-rays have a $25 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellcare Patriot Simple (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Patriot Simple (HMO-POS) covers some cardiac rehabilitation services with no coinsurance, but several specific sub-services are not covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Wellcare Patriot Simple (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 41 to 100, while days 21 to 40 require a $218 daily copay; prior authorization is required, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Wellcare Patriot Simple (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The meal benefit requires a referral for eligible conditions, and OTC items are obtained via reimbursement.
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