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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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 $7500.00 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) Medicare plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 6 select care drugs, and no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options are also available for generic drugs, with copays ranging from $5 to $30 depending on the tier and supply length. For brand-name and specialty medications, your costs will be determined by coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs both carry a 25% coinsurance, while Tier 4 non-preferred drugs require either 42% or 43% coinsurance depending on whether you use a preferred or standard pharmacy.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits, home health services, and annual physicals. Specialist visits, physical therapy, and occupational therapy require a $20 copay with no coinsurance. For hospital care, inpatient stays carry a $375 daily copay for the first seven days and no copay for days 8 through 90, while outpatient hospital services range from no copay to a $475 copay. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental services with no copay up to a $5,000 annual limit. Routine hearing and vision exams also feature no copay, with allowances of up to $1,500 per ear for hearing aids and $200 annually for eyewear. Additionally, members benefit from up to 24 one-way transportation trips per year with no copay and no copay for chronic illness meals.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Simple (HMO-POS) with no coinsurance, though prior authorization is required. Acute care requires a $375 daily copay for days 1 through 7 and no copay for days 8 through 90, while psychiatric care has a $1,871 copay per stay. Additional days, upgrades, and non-Medicare-covered stays are not covered under these benefits.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services with no coinsurance, featuring copays of $0 to $475 for outpatient hospital services, $115 to $475 per stay for observation services, and $325 for ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Simple (HMO-POS) plan with a $105.00 copay and no coinsurance, subject to prior authorization.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $350 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) offers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $20 copay and no coinsurance. Routine chiropractic care is partially covered with a $15 copay and no coinsurance for up to 12 visits yearly, but other chiropractic and podiatry services are not covered. Mental health, psychiatric, and telehealth services are also covered with no coinsurance and copays ranging from $0 to $25.
Preventive Services See details
Wellcare Simple (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for annual physicals, fitness benefits, remote access, alternative therapies, and screenings, though kidney disease education requires a 20% coinsurance and no copay. Uncovered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Wellcare Simple (HMO-POS) covers Medicare-covered hearing exams with a $20 copay and no coinsurance, while routine hearing exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are covered up to $1,500 per ear annually with no copay and no coinsurance, although inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Simple (HMO-POS), featuring eye exams with no copay to a $20 copay and no coinsurance, though other eye exam services are not covered. Eyewear, including contact lenses and eyeglasses, is covered with no copay and no coinsurance up to a $200 annual maximum.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), offering preventive and most comprehensive services with no copay and no coinsurance up to a $5,000 annual maximum. Medicare-covered dental services require a $20 copay and no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, and prior authorization is required for most medical equipment benefits.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and no coinsurance, and diagnostic tests with a copay of $0 to $100 and no coinsurance. Diagnostic radiological services require a copay starting at $0, outpatient X-rays carry a $40 copay, and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) offers cardiac rehabilitation services with no coinsurance, but some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered, carrying copays between $20 and $40.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Wellcare Simple (HMO-POS) with no coinsurance, requiring no copay for days 1 to 20 and 61 to 100, and a $218 daily copay for days 21 to 60. Prior authorization is required and less than a 3-day inpatient hospital stay is allowed, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, offering acupuncture and chronic illness meal benefits with no copay and no coinsurance, while over-the-counter (OTC) items are not covered.
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