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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 2025, 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 3.5 out of 5 stars in 2025.
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 $37.00. 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 $420.00 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:
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Drug Coverage
The Wellcare Low Premium (HMO-POS) plan has a $420 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 25% coinsurance. This plan offers an "Enhanced Alternative" drug benefit. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you will pay $7.00.
Additional Benefits
The Wellcare Low Premium (HMO-POS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services and many primary care visits have copays. Emergency and urgent care services are covered, and preventive services, including an annual physical, are covered with no copay. This plan also includes coverage for hearing, vision, and dental services, with copays for some services and no copays for others. Additional benefits include home health services with no copay, and coverage for medical equipment, diagnostic services, and skilled nursing facilities. However, cardiac rehabilitation services are not covered, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $350 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $280 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days, and non-medicare covered stays for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $400, observation services with a copay between $125 and $400, ambulatory surgical center services with a $185 copay, and outpatient substance abuse services with a $25 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Low Premium (HMO-POS) plan, but requires prior authorization. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $275 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare Low Premium (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services have a $40 copay, with no coinsurance for any of these services. Worldwide Urgent Coverage has a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic services are covered with a $10 copay, but routine care is not covered. Occupational Therapy Services have a $10 copay and no coinsurance. Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services all have a $10 copay. Additional Telehealth Benefits have a copay between $0-$40. Opioid Treatment Program Services have a $10 copay.
Preventive Services See details
Preventive services, including an annual physical exam, are covered under the Wellcare Low Premium (HMO-POS) plan with no copay. Kidney disease education services have a 20% coinsurance. Other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing Services include Hearing Exams with a $10 copay, Routine Hearing Exams with no copay, and Fitting/Evaluation for Hearing Aid with no copay. Prescription Hearing Aids are covered with a plan-specified amount of $500 per ear every year, and there is no copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
The Wellcare Low Premium (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $10, while routine eye exams have no copay; eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all have no copay, with a combined maximum benefit of $300 per year.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $10 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, and Prosthodontics, fixed, and Oral and Maxillofacial Surgery with no copay. Orthodontic Services are covered with a maximum benefit of $3,000 per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Low Premium (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Low Premium (HMO-POS) plan, including Durable Medical Equipment with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying copays and coinsurance depending on the service. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $20, and lab services with no copay. Diagnostic Radiological Services have a copay up to $280, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Low Premium (HMO-POS) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Low Premium (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Low Premium (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, a $214 copay for days 21-60, and no copay for days 61-100. Additional days beyond Medicare-covered for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefit, with no copay for either. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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