A non-government entity
Wellcare Low Premium (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Low Premium (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Low Premium (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Low Premium (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in MS. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Low Premium (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 Low Premium (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 Low Premium (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.00. 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 $5600.00 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:
Sign up for Wellcare Low Premium (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Low Premium (HMO-POS) prescription drug plan features an annual drug deductible of $615. You can save on medication costs with no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using preferred pharmacies or preferred mail-order services. Standard pharmacies are also available, offering Tier 1 and Tier 2 drugs with copays starting at $5 and $10, respectively. For brand-name and specialty medications, costs are calculated using coinsurance. Tier 3 preferred brands and Tier 5 specialty drugs both require a 25% coinsurance payment. Tier 4 non-preferred drugs incur a 37% coinsurance at preferred pharmacies and a 38% coinsurance at standard pharmacies.
Additional Benefits
The Wellcare Low Premium (HMO-POS) plan offers comprehensive coverage with an emphasis on low out-of-pocket costs for everyday healthcare needs. You will pay no copay and no coinsurance for primary care visits, routine dental care up to a $3,000 annual limit, routine annual vision and hearing exams, and home health services. Routine preventive services and over-the-counter items are also fully covered with no copays. For specialized or emergency care, the plan utilizes predictable copays and coinsurance to help you manage your healthcare budget. Specialist visits and physical therapy require a low $10 copay, while emergency room visits have a $130 copay, and acute inpatient hospital stays require a $350 daily copay for the first 7 days. Durable medical equipment and dialysis services are covered with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Wellcare Low Premium (HMO-POS) inpatient hospital care is partially covered with no coinsurance, requiring prior authorization, but excludes upgrades, additional days, and non-Medicare-covered stays. Medicare-covered acute stays require a $350 daily copay for days 1 to 7 (no copay for days 8 to 90), and psychiatric stays require a $280 daily copay for days 1 to 5 (no copay for days 6 to 90).
Outpatient Services See details
Wellcare Low Premium (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $400 for outpatient hospital services and $130 to $400 per stay for observation services. Ambulatory surgical center services require a $185 copay, outpatient substance abuse sessions have a $25 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Low Premium (HMO-POS) with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services are covered by Wellcare Low Premium (HMO-POS) with a $275 copay and no coinsurance for both ground and air services, which require prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Wellcare Low Premium (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $40 copay, featuring no coinsurance for either service and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 lifetime maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Low Premium (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $10 copay and no coinsurance. Mental health and psychiatric services have a $25 copay and no coinsurance, telehealth benefits range from a $0 to $40 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Wellcare Low Premium (HMO-POS), offering no copay and no coinsurance for annual physical exams, fitness benefits, alternative therapies, and various screenings. Kidney disease education is covered with no copay and a 20% coinsurance, but several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Wellcare Low Premium (HMO-POS) covers hearing exams with a $10 copay for Medicare-covered exams and no copay for routine annual exams and fittings, with no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $500 per ear annually, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Low Premium (HMO-POS) vision services are partially covered, offering one annual routine eye exam with no copay or coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $400 annual maximum benefit for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Wellcare Low Premium (HMO-POS), featuring no copay and no coinsurance for preventive and most comprehensive care up to a $3,000 annual limit. Medicare-covered dental services require a $10 copay and no coinsurance, while implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Wellcare Low Premium (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 and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellcare Low Premium (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Low Premium (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, with prior authorization needed for most items.
Diagnostic and Radiological Services See details
Wellcare Low Premium (HMO-POS) covers diagnostic and radiological services with no coinsurance and a $0 to $20 copay for diagnostic procedures, alongside no copay for lab services. Radiological services are also covered, featuring no copay for diagnostic radiology, a $35 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Wellcare Low Premium (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Wellcare Low Premium (HMO-POS) plan with no coinsurance, though some services are not covered. These non-covered services include standard cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay).
Skilled Nursing Facility (SNF) See details
Wellcare Low Premium (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, though additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20 and days 51 through 100, but a $218 copay per day is required for days 21 through 50.
Other Services See details
Wellcare Low Premium (HMO-POS) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance. However, acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved