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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 2026 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 $9250.00 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) prescription drug plan has an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or preferred mail order. Additionally, Tier 6 select care drugs are highly accessible, featuring no copay at both preferred and standard pharmacies. For higher-tier medications, the plan utilizes coinsurance, requiring a 25% coinsurance for Tier 3 preferred brands and Tier 5 specialty drugs. Tier 4 non-preferred drugs carry a 36% coinsurance at preferred locations and a 37% coinsurance at standard locations. Standard pharmacies also offer coverage for generic tiers with copays ranging from $5 to $30 depending on the drug tier and supply.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care doctor visits, standard preventive services, and home health care. For hospital stays, inpatient care requires a daily copay of $375 for the first seven days and no copay for days eight through 90, while emergency room visits carry a $115 copay. Specialist visits, outpatient hospital services, and ambulance transportation are also covered with fixed copays and no coinsurance. Routine dental services and annual eye exams are covered with no copay, and the plan includes a $100 annual allowance for eyewear, though routine hearing exams and hearing aids are not covered. Essential medical equipment, prosthetics, and dialysis require no copay with a 20% coinsurance, whereas diabetic supplies are covered with no copay. Members can also take advantage of extra benefits like fitness programs, acupuncture, and chronic illness meals with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Wellcare Simple (HMO-POS) with no coinsurance, though prior authorization is required. Medicare-covered acute stays require a $375 daily copay for days 1 through 7 and no copay for days 8 through 90, while psychiatric stays require a $1,871 copay per stay. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $500 for outpatient hospital services and a $425 copay for ambulatory surgical center services. Outpatient substance abuse services require a $25 copay with no coinsurance, while outpatient blood services are fully covered with no copay and no coinsurance.
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 receive this covered benefit.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers Medicare-approved ground and air ambulance services with a $350 copay and no coinsurance, requiring prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted within 24 hours, and urgent care with a $25 copay and no coinsurance. 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, while specialist visits, physical therapy, and mental health services require copays ranging from $10 to $40 and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance for routine care, though other chiropractic services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) offers partially covered preventive services, including annual physicals, fitness benefits, alternative therapies, and remote access with no copay and no coinsurance, and kidney disease education with no copay and 20% coinsurance. Sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services covered by Wellcare Simple (HMO-POS) include hearing exams with a $40 copay, no coinsurance, and no deductible, though prior authorization is required. However, routine hearing exams, fitting and evaluations, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Wellcare Simple (HMO-POS), which offers one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance, up to a $100 combined annual maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), with Medicare-covered dental requiring a $40 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and prior authorization is required for most covered services.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 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
Wellcare Simple (HMO-POS) covers medical equipment, including durable medical equipment (DME), 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. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO-POS) with prior authorization required. Diagnostic services require no coinsurance, featuring no copay for lab services and a $0 to $100 copay for tests, while radiological services include a $50 copay for X-rays, a 20% coinsurance for therapeutic radiology, and diagnostic radiology copays starting at $0.
Home Health Services See details
Home health services are covered under the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Wellcare Simple (HMO-POS) with no coinsurance, but only some services are covered. Standard Cardiac Rehabilitation (with a $30 copay), Intensive Cardiac Rehabilitation ($40 copay), Pulmonary Rehabilitation ($25 copay), and SET for PAD services ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Wellcare Simple (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 days 71 to 100, a $218 daily copay for days 21 to 70, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Wellcare Simple (HMO-POS), offering acupuncture and chronic illness meal benefits with no copay and no coinsurance, while over-the-counter (OTC) items are not covered. Acupuncture is limited to 24 treatments per year with prior authorization required, and a referral is needed for the meal benefit.
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