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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 NE. This plan received an overall rating of 3 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 $5000.00 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 features an annual drug deductible of $615. Plan members enjoy no copay for Tier 1 preferred generics and Tier 2 generics when using preferred pharmacies or preferred mail order, and no copay for Tier 6 select care drugs at all pharmacies. Standard pharmacies offer these generic drugs with low copays starting at just $5 for Tier 1 and $10 for Tier 2 for a one-month supply. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs both require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 36% coinsurance at preferred pharmacies and 37% coinsurance at standard pharmacies. This straightforward cost-sharing structure helps you easily estimate your out-of-pocket prescription expenses.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits and physical therapy, members pay a predictable $35 copay with no coinsurance. Inpatient hospital stays require a daily copay for the first seven days, after which there is no copay, while emergency services are covered with a $130 copay. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copay. Covered prescription hearing aids, eyewear, and select comprehensive dental services are available with no copay or coinsurance up to specified annual dollar limits. Additionally, members benefit from no copay for over-the-counter items and home-delivered meals, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $375 copay for days 1 through 7 and no copay for days 8 through 90, while psychiatric care requires a $325 copay for days 1 through 7 and no copay for days 8 through 90. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from no copay to $400, and ambulatory surgical center services with a $300 copay and no coinsurance. Outpatient substance abuse services require a $40 copay with no coinsurance, while outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple (HMO-POS) with a $140.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. For transportation, some services are covered but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and opioid treatment require a $35 copay with no coinsurance. Mental health and psychiatric services have a $40 copay with no coinsurance, telehealth services range from a $0 to $50 copay, and podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Wellcare Simple (HMO-POS), featuring no copay and no coinsurance for annual physicals, fitness benefits, alternative therapies, and routine screenings, while kidney disease education has no copay and a 20% coinsurance. Excluded sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services under Wellcare Simple (HMO-POS) are covered, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $750 annual limit per ear, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) vision services are partially covered with no deductible and no coinsurance, featuring eye exam copays ranging from $0 to $35 and no copay for eyewear up to a $200 annual limit. While one routine eye exam per year is covered with no copay, other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), offering Medicare-covered dental for a $35 copay and no coinsurance, alongside covered preventive and select comprehensive services with no copay or coinsurance up to a $1,000 annual maximum. Prosthodontics (fixed and removable), implants, orthodontics, and maxillofacial prosthetics 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. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers medical equipment, including 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.
Diagnostic and Radiological Services See details
Diagnostic and radiological services under Wellcare Simple (HMO-POS) are covered, though prior authorization is required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $50 copay for tests, while radiological services require a $50 copay for X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Wellcare Simple (HMO-POS) feature no coinsurance, and while some services are covered, several key programs are not covered. Specifically, standard cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is 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 through 20 and days 51 through 100, a $218 daily copay for days 21 through 50, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, providing over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. A referral is required for the meal benefit, while acupuncture and other miscellaneous services are not covered.
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