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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 2025, 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 3.5 out of 5 stars in 2025.
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 $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 $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 has a $420 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy type. For example, you will have no copay for preferred generic drugs at a preferred pharmacy, while you pay 25% coinsurance for standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, if you qualify for the low-income subsidy, you may have your premium reduced. The plan's formulary provides specific details on the drugs covered.
Additional Benefits
The Wellcare Simple Preferred (HMO-POS) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. This plan has no copay for primary care, preventive services such as annual physicals, and many dental services. Additional benefits include coverage for hearing and vision services, with copays for exams and eyewear, and coverage for home health services with no copay. The plan also covers ambulance services, though with a copay.
Inpatient Hospital See details
Inpatient hospital services are covered by the Wellcare Simple Preferred (HMO-POS) plan, with a copay of $350 per day for days 1-6 and no copay for days 7-90 for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, along with upgrades for Inpatient Hospital-Acute.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a copay between $125 and $350, Ambulatory Surgical Center (ASC) Services with a $250 copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay of $40, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple Preferred (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $300 copay for both ground and air ambulance services, and 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 have a copay of $125, $35, and $125 respectively, with no coinsurance. Worldwide Urgent Coverage has a copay of $125, with no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Preferred (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay (prior authorization required), and occupational therapy services with a $30 copay (prior authorization required). The plan also covers physician specialist services with a $25 copay, mental health specialty services with a copay of $40 for individual or group sessions (prior authorization required), and podiatry services with a $25 copay (prior authorization required). The plan also covers other health care professionals with a copay between $0 and $25, psychiatric services with a copay of $40 for individual or group sessions, and physical therapy and speech-language pathology services with a $30 copay (prior authorization required). Additional telehealth benefits have a copay between $0 and $40 (prior authorization required), and opioid treatment program services have a $25 copay (prior authorization required). Routine Chiropractic Care is not covered.
Preventive Services See details
The Wellcare Simple Preferred (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Alternative Therapies, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), have a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay.
Hearing Services See details
Hearing exams are covered with a $25 copay, routine hearing exams are covered with no copay for one visit every year, and fitting/evaluation for hearing aids are covered with no copay for one visit every year. Prescription hearing aids are covered with a plan-specified amount of $500 per ear every year with no copay for all types, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Wellcare Simple Preferred (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$25 and eyewear with no copay. The plan provides a combined maximum of $200 for eyewear every year.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery, all with no copay. Orthodontic Services are covered up to a maximum of $1000 per year. Prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple Preferred (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services. Diagnostic procedures/tests have a copay between $0 and $20, lab services have no copay, diagnostic radiological services have a copay up to $290, therapeutic radiological services have 20% coinsurance, and outpatient X-Ray services have a $75 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple Preferred (HMO-POS) plan with no copay and no coinsurance. 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 Simple Preferred (HMO-POS) plan. While Cardiac Rehabilitation Services are generally covered, the plan does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Preferred (HMO-POS) plan, but require prior authorization. For days 1-20 and days 51-100, there is no copay; for days 21-50, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Simple Preferred (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $111.00 every three months. 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. Meal benefits are covered with no copay and require a doctor's referral.
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