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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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Simple (HMO-POS) is a HMO-POS plan offered by Wellcare of Georgia, Inc. available for the 2026 plan year 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7900.00 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 an annual prescription drug deductible of $615. Under this plan, you will enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications when using a preferred pharmacy or preferred mail-order service. Tier 6 select care drugs also feature no copay regardless of whether you use a preferred or standard pharmacy. For other medications, costs are based on coinsurance, including a 25% coinsurance for Tier 3 preferred brand drugs and Tier 5 specialty drugs. Tier 4 non-preferred drugs require a 35% coinsurance at preferred pharmacies and 36% coinsurance at standard pharmacies. Utilizing preferred pharmacies and mail-order services with this plan will help you minimize out-of-pocket prescription costs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers robust coverage for essential medical services with predictable out-of-pocket costs. Members benefit from no copay for primary care doctor visits, while specialist consultations and physical therapy require a low $15 copay. For hospital care, inpatient stays carry a $375 daily copay for the first seven days followed by no copay, and emergency room visits have a $115 copay. This plan also includes comprehensive supplemental benefits to support your overall well-being. Preventive and most comprehensive dental services are covered with no copay up to a generous $5,000 annual maximum, alongside no-copay routine vision and hearing exams. Additionally, members can access home health services and acupuncture at no cost, though cardiac rehabilitation and over-the-counter items are not covered under this plan.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient acute hospital stays with no coinsurance and a $375 daily copay for days 1 through 7, followed by no copay for days 8 through 90. Inpatient psychiatric care is also covered with no coinsurance and a $1,871 copay per stay, though prior authorization is required and additional non-Medicare-covered days are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient hospital services with a $0 to $475 copay and ambulatory surgical center services with a $325 copay, both with no coinsurance. Outpatient substance abuse services have a $25 copay per session and no coinsurance, while outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ambulance services with a $350 copay and no coinsurance for ground and air transport, while transportation services are partially covered with no copay or coinsurance. Covered transportation is limited to 12 one-way trips per year to plan-approved locations, but trips to any health-related location are 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 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, 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, though the overall benefit is partially covered as podiatry and non-routine chiropractic services are not covered. Covered specialist visits, physical therapy, and routine chiropractic care require a $15 copay and no coinsurance, while mental health and psychiatric services have a $25 copay and no coinsurance.
Preventive Services See details
Wellcare Simple (HMO-POS) features partially covered preventive services, offering no copay and no coinsurance for annual physicals, fitness benefits, alternative therapies, remote access, and various screenings. Kidney disease education is covered with no copay and a 20% coinsurance, but sub-services such as health education, PERS, medical nutrition therapy, weight management, in-home safety assessments, medication reconciliation, re-admission prevention, wigs, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Simple (HMO-POS) with no coinsurance, requiring a $15 copay for Medicare-covered exams and no copay for annual routine exams, fitting evaluations, and prescription hearing aids up to $1,000 per ear. Prior authorization is required for coverage, and OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) vision services are partially covered, offering one routine eye exam per year with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance up to a $200 annual maximum benefit for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Wellcare Simple (HMO-POS) offers partially covered dental services with a $15 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and most comprehensive services up to a $5,000 annual maximum. Prior authorization is required for most services, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, subject to prior authorization and step therapy. Under this benefit, Medicare Part B insulin requires a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Simple (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Simple (HMO-POS) with prior authorization required for most services. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require no copay and a 20% coinsurance, while diabetic supplies are covered with no copay.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services with prior authorization required, offering diagnostic lab services with no copay or coinsurance and diagnostic tests with no coinsurance and copays ranging from $0 to $100. Outpatient X-rays carry a $40 copay, diagnostic radiology copays start at $0, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Wellcare Simple (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) does not cover Cardiac Rehabilitation Services, as all associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Simple (HMO-POS) with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20 and days 61 through 100, but a $218 daily copay applies for days 21 through 60, and 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.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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