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Wellcare Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Assist (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 Assist (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 Assist (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 Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.40. 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 $565.00 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 Assist (HMO-POS) prescription drug plan features an annual deductible of $565. Tier 6 select care drugs feature no copay for all supply durations at both standard and preferred pharmacies. For Tier 1 preferred generics and Tier 2 generics, 1-month copays start as low as $18 and $19 respectively, with no copay for a 3-month supply filled via preferred mail order. For higher-tier medications, Tier 3 preferred brands require a 20% coinsurance across all pharmacy and mail order channels. Tier 4 non-preferred drugs have a coinsurance between 36% and 40%, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. Utilizing preferred pharmacies and preferred mail order services provides the most cost-effective savings on this plan.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits, annual physical exams, and fitness benefits. For specialist visits, physical therapy, and urgent care, members pay a low $15 to $25 copay with no coinsurance. Inpatient hospital stays require a $325 daily copay for the first eight days, followed by no copay for days 9 through 100. This plan also provides robust supplemental benefits, including routine dental, vision, and hearing services with no copay or coinsurance, alongside allowances for hearing aids and eyewear. Additional perks include no copay for home health services, acupuncture, and over-the-counter items, while durable medical equipment and dialysis require a 20% coinsurance. Transportation is also covered with no copay for up to 12 one-way trips per year to plan-approved locations.
Inpatient Hospital See details
Wellcare Assist (HMO-POS) covers inpatient acute hospital stays with no coinsurance, requiring a $325 daily copay for days 1 to 8 and no copay for days 9 to 100, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance and a $2,075 copay per stay, but additional days and non-Medicare-covered stays are excluded.
Outpatient Services See details
Wellcare Assist (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $450 and observation services with a $115 to $450 copay per stay. Ambulatory surgical center services require a $300 copay with no coinsurance, outpatient substance abuse sessions have a $25 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellcare Assist (HMO-POS) with a $105.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellcare Assist (HMO-POS) covers ground and air ambulance services with a $350 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Assist (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 admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO-POS) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and opioid treatment require a $15 copay and no coinsurance. Mental health and psychiatric sessions have a $25 copay, telehealth and other professional services range up to a $25 copay with no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Assist (HMO-POS) covers preventive services, including annual physical exams, fitness benefits, and alternative therapies with no copay and no coinsurance. Kidney disease education is covered with no copay and 20% coinsurance, but other supplemental benefits are only partially covered, with services like health education, weight management, and in-home support excluded from coverage.
Hearing Services See details
Hearing services under Wellcare Assist (HMO-POS) are partially covered, featuring a $15 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Wellcare Assist (HMO-POS) provides partially covered vision services with no deductibles, featuring one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Covered eyewear options like contacts and eyeglasses also have no copay and no coinsurance, up to a $100 annual maximum benefit.
Dental Services See details
Wellcare Assist (HMO-POS) covers Medicare-covered dental services with a $15 copay and no coinsurance, and preventive and most comprehensive dental services with no copay and no coinsurance up to a $2,000 annual maximum. This benefit is partially covered, as implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Assist (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellcare Assist (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Assist (HMO-POS), with diagnostic services requiring no coinsurance, no copay for lab services, and diagnostic tests ranging from a $0 to $100 copay. Radiological services require prior authorization and include outpatient X-rays with a $50 copay and coinsurance, therapeutic services with a minimum 20% coinsurance, and diagnostic radiology with copays starting at $0.
Home Health Services See details
Home health services are covered by Wellcare Assist (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Assist (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Assist (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and 61 to 100, a $218 daily copay for days 21 to 60, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other services are partially covered by Wellcare Assist (HMO-POS), which offers acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits with no copay and no coinsurance. Acupuncture (limited to 12 treatments yearly) and meal benefits require prior authorization or referrals, while Dual Eligible SNPs with Highly Integrated Services are not covered.
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