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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 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 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 $16.30. 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 Assist (HMO-POS) prescription drug plan features an annual drug deductible of $615. For Tier 6 Select Care Drugs, members pay no copay for any supply duration at either preferred or standard pharmacies. Tier 1 Preferred Generic and Tier 2 Generic medications offer copays starting at $18 and $19 for a one-month supply, with no copay for three-month supplies filled through preferred mail order. Higher-tier medications under this plan transition to coinsurance or higher copays, such as Tier 3 Preferred Brand drugs which require a 21% to 22% coinsurance. Tier 4 Non-Preferred drugs have a flat $100 copay for a one-month supply, while Tier 5 Specialty Tier drugs require a 25% coinsurance. Utilizing preferred pharmacies and preferred mail-order options helps secure the lowest out-of-pocket costs for your prescriptions.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive screenings, and home health services. For specialized medical care, members pay predictable copays, such as $20 for specialist visits and $130 for emergency room care, with no coinsurance required. Inpatient hospital stays are subject to daily copays for the first several days, after which stays are covered with no copay. This plan also provides valuable supplemental benefits, including routine dental and vision care with no copays, featuring a generous $4,000 annual dental limit and $300 annually for eyewear. Additionally, members benefit from hearing aid coverage of up to $500 per ear annually and over-the-counter items with no copays. For durable medical equipment, dialysis services, and certain Part B drugs, a 20% coinsurance applies with no copay.
Inpatient Hospital See details
Wellcare Assist (HMO-POS) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute inpatient stays, there is a $350 daily copay for days 1-8 and no copay for days 9-95, while upgrades and non-Medicare-covered stays are not covered. Psychiatric inpatient stays carry a $325 daily copay for days 1-7 and no copay for days 8-90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Assist (HMO-POS) covers outpatient services with no coinsurance, featuring a copay of $0 to $300 for outpatient hospital services and $130 to $300 per stay for observation services. Ambulatory surgical center services require a $250 copay, outpatient substance abuse sessions have a $25 copay, and outpatient blood services are covered with no copay and no deductible.
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 receive coverage for these services.
Ambulance and Transportation Services See details
Wellcare Assist (HMO-POS) partially covers ambulance and transportation services, offering ground and air ambulance services with a $230 copay and no coinsurance, subject to prior authorization. For transportation, some services are covered but transportation to plan-approved health-related locations and any health-related locations 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, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially 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) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $20 copay and no coinsurance. Mental health and psychiatric specialty services feature a $25 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Assist (HMO-POS) covers annual physical exams and other preventive screenings with no copay and no coinsurance, while kidney disease education is covered with no copay and 20% coinsurance. Additional preventive services are partially covered, offering fitness benefits, remote access, and alternative therapies with no copay and no coinsurance, while excluding services like health education, weight management, nutritional services, and personal emergency response systems.
Hearing Services See details
Hearing services are covered by Wellcare Assist (HMO-POS), offering Medicare-covered exams for a $20 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered up to $500 per ear annually with no copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Assist (HMO-POS) provides partially covered vision services with no copay or coinsurance, including one routine eye exam per year and up to $300 annually for eyewear such as contacts, lenses, and frames. Prior authorization is required for these benefits, and other eye exam services are not covered.
Dental Services See details
Wellcare Assist (HMO-POS) covers Medicare-approved dental services with a $20 copay and no coinsurance, while preventive and most comprehensive dental services are covered with no copay and no coinsurance up to a $4,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
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 plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while other Part B drugs, including chemotherapy and radiation, have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Wellcare Assist (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with no copays and a 20% coinsurance for most items. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Assist (HMO-POS), offering lab services with no copay or coinsurance, and diagnostic tests with a $0 to $20 copay and no coinsurance. Diagnostic radiological services feature copays starting at $0, outpatient X-rays require a $45 copay, and therapeutic radiological services incur a minimum 20% coinsurance.
Home Health Services See details
Wellcare Assist (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Wellcare Assist (HMO-POS) with no coinsurance, and while some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require copays of $40, $50, $35, and $25 respectively.
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 inpatient hospital stay. There is no copay for days 1 through 20 and days 51 through 100, a $218 daily copay for days 21 through 50, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Wellcare Assist (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture and meal benefits are not covered. Covered OTC items are provided via reimbursement and include nicotine replacement therapy and naloxone.
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