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Wellcare Simple Preferred (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Preferred (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 Preferred (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Simple Preferred (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in AR. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Simple Preferred (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 Preferred (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 Preferred (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 $6000.00 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 Preferred (HMO-POS) plan features an Enhanced Alternative drug benefit with a $615 prescription drug deductible. If you qualify for the Low-Income Subsidy, your Part D premium can be reduced to $0. After meeting your deductible, you enter the initial coverage phase until total drug costs reach $2,100, after which you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. During the initial coverage phase, Tier 1 preferred generic drugs have no copay at preferred pharmacies and a $10 copay at standard pharmacies, while Tier 5 specialty drugs require no copay at either pharmacy type. Other tiers require coinsurance, including 25% for Tier 2 standard generics and Tier 4 non-preferred drugs at both pharmacy types, and 37% to 38% for Tier 3 preferred brand drugs.
Additional Benefits
The Wellcare Simple Preferred (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care provider visits and low copays ranging from $15 to $40 for specialist visits. Emergency care is covered with a $115 copay, while urgent care requires a $35 copay, both with no coinsurance. For hospital stays, members pay a $350 daily copay for the first six days of acute inpatient care and no copay for subsequent days. Routine services like annual preventive exams, routine eye exams, and dental cleanings are highly accessible with no copay and no coinsurance. The plan also includes generous allowances for extra benefits, providing up to $1,000 annually for dental services, $200 for eyewear, and $500 per ear for prescription hearing aids with no copays. Additionally, home health services and diabetic supplies are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Wellcare Simple Preferred (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, with no copay for subsequent days. Additional days, upgrades, and non-Medicare-covered stays are not covered under these benefits.
Outpatient Services See details
Outpatient services are covered by Wellcare Simple Preferred (HMO-POS) with no coinsurance and copays ranging from no copay for blood services up to $350 for hospital and observation services. Ambulatory surgical center services require a $300 copay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Wellcare Simple Preferred (HMO-POS) with a $105 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Wellcare Simple Preferred (HMO-POS), with ground and air ambulance services requiring a $300 copay and no coinsurance. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Wellcare Simple Preferred (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $35 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered with a $115 copay and no coinsurance up to a $50,000 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are partially covered by Wellcare Simple Preferred (HMO-POS) with no coinsurance, featuring no copay for primary care provider visits and copays ranging from $15 to $40 for specialists, therapy, and mental health services. Podiatry services and routine chiropractic care are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Wellcare Simple Preferred (HMO-POS), featuring no copay and no coinsurance for annual exams, fitness benefits, and screenings, while kidney disease education requires a 20% coinsurance and no copay. Sub-services such as health education, weight management, therapeutic massage, medical nutrition therapy, and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Simple Preferred (HMO-POS) provides partially covered hearing services with no coinsurance and no deductibles, featuring a $25 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $500 per ear annually with no copay, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Simple Preferred (HMO-POS) covers vision services, offering annual routine eye exams with no copay and other eye exams with a copay of $0 to $25, with no coinsurance or deductibles required. The plan also features a $200 annual maximum benefit for eyewear, including glasses and contact lenses, with no copay or coinsurance.
Dental Services See details
Dental services are partially covered by Wellcare Simple Preferred (HMO-POS), with Medicare-covered dental services requiring a $25 copay and no coinsurance. Preventive and comprehensive benefits—including oral exams, cleanings, x-rays, restorative services, endodontics, periodontics, prosthodontics, and oral surgery—have no copay and no coinsurance up to a $1,000 annual maximum, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple Preferred (HMO-POS) covers home infusion bundled services, which require prior authorization and may be subject to step therapy. Covered Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered by Wellcare Simple Preferred (HMO-POS) with 20% coinsurance and no copay.
Medical Equipment See details
Wellcare Simple Preferred (HMO-POS) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Wellcare Simple Preferred (HMO-POS) covers diagnostic and radiological services, with prior authorization required. Diagnostic tests and radiological services feature copays ranging from no copay up to $290, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellcare Simple Preferred (HMO-POS) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Wellcare Simple Preferred (HMO-POS) indicates some services are covered for cardiac rehabilitation, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Because these services are not covered in practice, there are no copays or coinsurance costs for them.
Skilled Nursing Facility (SNF) See details
Wellcare Simple Preferred (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 61 to 100, and a $218 daily copay for days 21 to 60. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Wellcare Simple Preferred (HMO-POS), providing over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan, and a doctor referral is required for the meal benefit.
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