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Wellcare Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 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 Simple (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare 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 out of 5 stars in 2025.
It's important to know that Wellcare Simple (HMO-POS) 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-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 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.
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 $7000.00 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-POS) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. For specialty tier drugs, there is no copay at any pharmacy. For other tiers, you pay coinsurance of 25% to 35%. After your total drug costs reach $2000, you will pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a wide array of benefits with varying costs. You'll find no copays for many services, including primary care visits, preventive services, routine hearing and eye exams, and dental services. However, some services have copays, such as inpatient hospital stays, outpatient services, and specialist visits. The plan also includes coverage for ambulance services, emergency and urgent care, and home health services, with specific copays or coinsurance depending on the service. Additionally, the plan covers services like hearing aids (up to $1500 per year), vision care, and certain medical equipment, with some services requiring prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-6, and no copay for days 7-90; additional days 91-100 have no copay. Inpatient Hospital Psychiatric has a copay of $1871. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
The Wellcare Simple (HMO-POS) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $475, observation services with a copay between $110 and $475, and ambulatory surgical center (ASC) services with a $325 copay. Outpatient substance abuse services are covered with a $25 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple (HMO-POS) plan. Ground and Air Ambulance Services have a $300 copay, and Transportation Services to a plan-approved health-related location are covered with no copay. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the Wellcare Simple (HMO-POS) plan with a $110 copay, and Urgent Services have a $25 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation is not covered. There is no coinsurance for any of these services.
Primary Care See details
The Wellcare Simple (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, and physician specialist services with a $20 copay. Mental health specialty services, including individual and group sessions, have a $25 copay, while physical therapy and speech-language pathology services have a $20 copay. Other covered services include additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with a $20 copay.
Preventive Services See details
Preventive services, including annual physical exams, are covered by the Wellcare Simple (HMO-POS) plan with no copay. Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, also have no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
The Wellcare Simple (HMO-POS) plan covers hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $1500 per year, with no copay. However, OTC hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$20, while routine eye exams have no copay. Eyewear has no copay and an annual combined maximum benefit of $200.
Dental Services See details
The Wellcare Simple (HMO-POS) plan covers dental services, including oral exams, dental X-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral surgery, with no copay for these services. Orthodontic services have a maximum benefit of $3,000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple (HMO-POS) plan. You will pay a coinsurance of 20% 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 with authorization required, while durable medical equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but no sub-services are covered. The plan does not list any copay or coinsurance information for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, for days 21-70, there is a $214 copay, and for days 71-100, there is no copay.
Other Services See details
Other Services include acupuncture and a meal benefit, with acupuncture requiring prior authorization and the meal benefit requiring a doctor referral. Acupuncture has no copay, and the meal benefit also has no copay. Over-the-counter (OTC) items, 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.
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