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Wellcare Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple (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 (HMO-POS) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Simple (HMO-POS) is a HMO-POS plan offered by Harmony Health Plan, Inc. available for the 2026 plan year 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 Simple (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 (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 (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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5500.00 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 (HMO-POS) prescription drug plan features an annual drug deductible of $615. Under this plan, you will enjoy no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 (Select Care Drugs) are available with no copay at all standard and preferred pharmacies. For higher-tier prescriptions, Tier 3 (Preferred Brand) and Tier 5 (Specialty) drugs require a 25% coinsurance. Tier 4 (Non-Preferred) drugs carry a 40% coinsurance at preferred pharmacies and a 42% coinsurance at standard pharmacies. Utilizing preferred network pharmacies and mail-order services helps maximize your savings under this plan.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits, patients pay a $25 copay, while inpatient hospital stays require a daily copay of $350 for the first eight days of acute care before transitioning to no copay. Emergency services are covered with a $130 copay, and urgent care visits require a $40 copay, with no coinsurance for either service. This plan also includes valuable supplemental benefits, featuring no copay and no coinsurance for routine dental, vision, and hearing exams, alongside a $3,000 annual maximum for comprehensive dental services. Additionally, prescription hearing aids are covered up to $500 per ear annually, and eyewear is covered up to $100 yearly with no copays. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, helping to keep your out-of-pocket costs predictable.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient hospital services with no coinsurance, although prior authorization is required. Acute care requires a $350 daily copay for days 1-8 and no copay for days 9-95, while psychiatric care has a $300 daily copay for days 1-6 and no copay for days 7-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under Wellcare Simple (HMO-POS) are covered with no coinsurance, featuring copays of $0 to $500 for outpatient hospital services and $130 to $500 per stay for observation services. Ambulatory surgical center visits require a $250 copay, outpatient substance abuse sessions carry a $25 copay, and outpatient blood services have no copay or deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Simple (HMO-POS) plan with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $300 copay per service, no coinsurance, and prior authorization requirements. Transportation services, including rides to plan-approved or health-related locations, are not covered under this plan.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Physical and occupational therapies require a $20 copay and no coinsurance, mental health services have a $25 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Wellcare Simple (HMO-POS), offering annual physical exams, fitness benefits, alternative therapies, and various screenings with no copay and no coinsurance. While kidney disease education is covered with no copay and a 20% coinsurance, multiple supplemental services such as health education, in-home safety assessments, and nutritional/dietary benefits are not covered.
Hearing Services See details
Wellcare Simple (HMO-POS) hearing services are partially covered, featuring a $25 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams and fittings with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) covers vision services with no coinsurance, offering no copay for one annual routine eye exam and up to $100 yearly for eyewear including contacts, frames, and lenses. Prior authorization is required for these benefits, and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), with Medicare-covered services requiring a $25 copay and no coinsurance, and other covered preventive and comprehensive services requiring no copay and no coinsurance. While comprehensive services are covered up to a $3,000 annual maximum, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, with no copays and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are covered with no copay.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance and diagnostic tests with a $0 to $20 copay and no coinsurance. Radiological services include outpatient X-rays with a $50 copay and coinsurance, therapeutic radiology with a copay and minimum 20% coinsurance, and diagnostic radiology with a minimum of no copay.
Home Health Services See details
Home Health Services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Simple (HMO-POS) with no coinsurance, though some services are covered in practice as standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. These non-covered rehabilitation services require copays ranging from $25 to $50.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients pay no copay for days 1 to 20 and days 51 to 100, a $218 daily copay for days 21 to 50, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Simple (HMO-POS), which provides over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered, and a referral is required to receive the meal benefit.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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