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Wellcare Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Assist (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in All counties in TN. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Assist (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 Assist (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 Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.70. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $4800.00 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 Assist (HMO-POS) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply at preferred pharmacies, with no copay required for three-month supplies filled via preferred mail order. Additionally, Tier 6 select care drugs are highly accessible with no copay across all pharmacy and mail order options. Higher-tier medications transition to coinsurance, with Tier 3 preferred brands requiring a flat 20% coinsurance at all pharmacies. Tier 4 non-preferred drugs carry a 32% or 33% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. Understanding these cost-sharing tiers helps you estimate your out-of-pocket costs and maximize your savings under this Medicare plan.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers comprehensive medical coverage with affordable cost-sharing, including no copay for primary care visits and a low $15 copay for specialist visits. Inpatient hospital stays feature daily copays for the first six days followed by no copay for subsequent days, while outpatient services range from no copay up to a $280 copay with no coinsurance. Emergency care is covered with a $130 copay, which is waived if you are admitted, and urgent care requires a $30 copay. Routine dental, vision, and hearing services are highly accessible, featuring no copays for routine exams alongside generous annual allowances like a $5,000 dental maximum and a $200 vision limit. Home health care requires no copay or coinsurance, while durable medical equipment and dialysis services are covered with no copay and a standard 20% coinsurance. Additionally, the plan provides convenient extras like no-copay routine transportation for up to 12 one-way trips per year to approved locations.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Assist (HMO-POS) with no coinsurance, though prior authorization is required. Acute care requires a $325 daily copay for days 1 to 6 and no copay for days 7 to 95, while psychiatric care requires a $275 daily copay for days 1 to 6 and no copay for days 7 to 90. Upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Assist (HMO-POS) outpatient services are covered with no coinsurance, featuring copays ranging from $0 to $280 for outpatient hospital care and $130 to $280 per stay for observation services. Additionally, ambulatory surgical center services require a $125 copay, outpatient substance abuse sessions carry a $40 copay, and blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Wellcare Assist (HMO-POS) with a $140.00 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Wellcare Assist (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance per service. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Assist (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $30 copay, featuring no coinsurance for either benefit and waived copays if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are also covered up to a $50,000 maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $15 copay and no coinsurance. Mental health and psychiatric services have a $40 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Assist (HMO-POS) offers partially covered preventive services with no copayments and no coinsurance for annual physical exams, fitness programs, alternative therapies, and select screenings. Kidney disease education is covered with no copay but requires a 20% coinsurance, while several other services such as health education, nutritional counseling, and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Assist (HMO-POS) covers hearing services, including Medicare-covered exams for a $15 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered up to $750 per ear annually with no copay or coinsurance, excluding inner ear, outer ear, and over-the-ear models, while OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Assist (HMO-POS), as other eye exam services are not covered. Routine eye exams and eyewear have no copay and no coinsurance, with a $200 annual limit for eyewear, while other eye exams require a copay of up to $15.00 with no coinsurance.
Dental Services See details
Wellcare Assist (HMO-POS) provides partially covered dental services with a $15 copay and no coinsurance for Medicare-covered care, and no copay or coinsurance for preventive and most comprehensive services up to a $5,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Wellcare Assist (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 a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellcare Assist (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist (HMO-POS) covers durable medical equipment (DME), prosthetics, medical supplies, and diabetic therapeutic shoes or inserts with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, and prior authorization is required for these medical equipment services.
Diagnostic and Radiological Services See details
Wellcare Assist (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance and diagnostic procedures with a $0 to $20 copay and no coinsurance. Diagnostic radiological services have a copay starting at $0 with no coinsurance, while outpatient X-rays require a $25 copay with coinsurance, and therapeutic radiological services carry a copay and a minimum 20% coinsurance.
Home Health Services See details
Wellcare Assist (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided with no coinsurance under Wellcare Assist (HMO-POS), but only some services are covered. Standard cardiac rehabilitation (with a $40 copay), intensive cardiac ($50 copay), pulmonary rehabilitation ($35 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Assist (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and 51 to 100, a daily copay of $218 for days 21 to 50, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Assist (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan.
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