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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 2025 to people living in Select counties in IL. 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 $3900.00 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. Beneficiaries can save on lower-tier medications, as there is no copay for Tier 1 preferred generics and Tier 2 generics at preferred pharmacies, and no copay for Tier 6 select care drugs at any network pharmacy. Standard retail pharmacies charge copays ranging from $5 to $30 for Tier 1 and Tier 2 prescriptions depending on the fill duration. For higher-tier medications, costs are determined by coinsurance rather than flat copays. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance. These coinsurance rates apply across both preferred and standard pharmacies, as well as mail-order services.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers affordable healthcare coverage featuring no copay and no coinsurance for primary care visits, routine preventive screenings, and urgent care services. For specialized medical needs, members can expect a low ten dollar copay for specialist visits and a daily copay of two hundred seventy-five dollars for the first eight days of inpatient hospital stays. Emergency care is available with a one hundred fifty dollar copay, which is waived if the patient is admitted to the hospital within twenty-four hours. This plan also provides robust supplemental benefits, including no copay for routine dental, vision, and hearing exams. Members benefit from generous annual allowances of up to five thousand dollars for dental services, fifteen hundred dollars for prescription hearing aids, and five hundred dollars for eyeglasses and contacts. Additionally, the plan covers up to twelve one-way transportation trips per year to approved locations with no copay or coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) inpatient hospital benefits are partially covered with no coinsurance, requiring a $275 daily copay for days 1 through 8 and no copay for days 9 through 90 for acute and psychiatric stays. Non-Medicare-covered stays and upgrades are not covered, though acute care includes five additional days with no copay.
Outpatient Services See details
Outpatient services under Wellcare Simple (HMO-POS) are covered with no coinsurance, featuring outpatient hospital copays ranging from $0 to $300 and ambulatory surgical center copays of $175. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are provided with no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellcare Simple (HMO-POS) with a $175.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $225 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Wellcare Simple (HMO-POS) with a $150 copay and no coinsurance (waived if admitted to the hospital within 24 hours), while urgently needed services have no copay and no coinsurance. Worldwide emergency and urgent services are also covered up to a $50,000 maximum with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) provides primary care physician services with no copay and no coinsurance, while specialist, physical therapy, occupational therapy, and opioid treatment services require a $10 copay and no coinsurance. Mental health and psychiatric sessions have a $40 copay and no coinsurance, telehealth benefits carry a $0 to $40 copay and 20% coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) partially covers preventive services, offering annual physicals, fitness benefits, alternative therapies, and screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Non-covered services include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services under Wellcare Simple (HMO-POS) are partially covered, offering Medicare-covered exams for a $10 copay and no coinsurance, alongside annual routine exams and fitting evaluations at no copay and no coinsurance. Prescription hearing aids are covered up to $1,500 annually with no copay or coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) partially covers vision services, offering eye exams with a $0 to $10 copay and eyewear with no copay, with no coinsurance or deductibles for either benefit. This coverage includes one routine eye exam per year and up to a $500 annual limit for contacts and eyeglasses, though other eye exam services are not covered.
Dental Services See details
Wellcare Simple (HMO-POS) covers Medicare dental services for a $10.00 copay and no coinsurance, and preventive and most comprehensive dental services with no copay and no coinsurance up to a $5,000 yearly maximum. Comprehensive dental is partially covered, as implant services, maxillofacial prosthetics, and orthodontics are not covered, and prior authorization is required for most 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 is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a coinsurance ranging from 0% to 20%.
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 durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services, with lab services and diagnostic radiological services starting at no copay and no coinsurance. Diagnostic procedures and tests range from a $0 to $50 copay with no coinsurance, while outpatient X-rays require a $50 copay plus coinsurance, and therapeutic radiology requires a copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance; however, only some services are covered, and standard cardiac rehabilitation (with a $50 copay), intensive cardiac rehabilitation (with a $65 copay), pulmonary rehabilitation (with a $40 copay), and supervised exercise therapy for PAD services (with a $30 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and days 41 through 100, but requiring a $218 daily copay for days 21 through 40. Prior authorization is required for these services, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) provides partial coverage for other services, which includes over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance, though meals require a referral. Acupuncture is not covered under this benefit.
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