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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 meeting your deductible, you'll pay varying costs depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for low-income subsidy, you may have reduced premium costs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a copay, and outpatient services have a mix of copays, including no copay for outpatient blood services. Preventive, hearing, and vision services are covered, with eye exams and some hearing services having no copay. Dental services are included with no copay for many services, but some services like orthodontics are not covered. The plan also includes ambulance, emergency, and transportation services, and covers home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Wellcare Simple (HMO-POS) plan. For Inpatient Hospital-Acute, you will pay a copay of $325 for days 1-6, and no copay for days 7-90. Inpatient Hospital Psychiatric services have a copay of $1871 per stay. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and 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, ambulatory surgical center services with a $325 copay, and outpatient substance abuse services with a $25 copay for both individual and group sessions. 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. You will have an $80 copay for this benefit.
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 $265 copay, and Transportation Services to a plan-approved health-related location are covered for 12 one-way trips per year with no copay; Transportation Services to any other health-related location are not covered.
Emergency Services See details
Emergency services are covered by the Wellcare Simple (HMO-POS) plan with a $110 copay and no coinsurance, and urgently needed services have a $25 copay and no coinsurance. Worldwide emergency coverage has a $110 copay and no coinsurance, while worldwide urgent coverage also has a $110 copay and no coinsurance; however, worldwide emergency transportation is not covered.
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 $15 copay, physician specialist services with a $15 copay, mental health specialty services with a $25 copay for individual and group sessions, other health care professional services with a $0-$15 copay, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a $0-$25 copay, and opioid treatment program services with a $15 copay. Podiatry services are not covered.
Preventive Services See details
The Wellcare Simple (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, but some services like health education, in-home safety assessments, and more are not covered. The plan also covers kidney disease education services with 20% coinsurance. Other preventive services, such as glaucoma screening, diabetes self-management training, and barium enemas, have no copay.
Hearing Services See details
Wellcare Simple (HMO-POS) covers hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum benefit of $1,000 per year, and Prescription Hearing Aids (all types) are covered with no copay; however, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a copay of $0-$15, and routine eye exams have no copay, and are limited to one per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, but are subject to a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $15 copay. Other Dental Services include oral exams, dental x-rays, and other diagnostic services with no copay, and prophylaxis cleaning, fluoride treatment, restorative services, and orthodontics with no copay. Orthodontic Services have a maximum plan benefit coverage of $3000 per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple (HMO-POS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits under the Wellcare Simple (HMO-POS) plan include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices, Medical Supplies, and Diabetic Equipment, with a 20% coinsurance for certain services. Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $45 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 not covered by the Wellcare Simple (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, for days 21-70 the copay is $214, and for days 71-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Simple (HMO-POS) plan covers acupuncture with no copay, but requires prior authorization and is limited to 24 treatments per year. Over-the-counter (OTC) items are covered with no copay, and include nicotine replacement therapy and Naloxone, up to a maximum of $70 every three months. The plan also covers a meal benefit with no copay and a doctor referral is required. However, other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many other services, are not covered.
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