A non-government entity
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 2025, please refer to our full plan details page.
Wellcare Simple (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 3.5 out of 5 stars in 2025.
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
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 $4900.00 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:
Sign up for Wellcare Simple (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple (HMO-POS) plan has a $420 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you will pay no copay for preferred generic drugs at a preferred pharmacy, but 25% coinsurance for standard generic drugs. For specialty tier drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for covered drugs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. Emergency services have a $125 copay, while primary care visits have no copay. The plan also covers preventive, hearing, vision, dental, and home health services, with services like routine eye exams, and hearing exams having no copay. Additional benefits include coverage for ambulance services, partial hospitalization, and some medical equipment, all with specific copays or coinsurance. The plan also covers home infusion services, dialysis, and skilled nursing facility stays, each with its own cost-sharing structure. There are also over-the-counter items and a meal benefit with no copay for these services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $350 for days 1-8 and no copay for days 9-90 for Inpatient Hospital-Acute stays, and a copay of $300 for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric stays. Additional days and non-Medicare-covered stays for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $300, observation services have a copay between $125 and $300, and ambulatory surgical center services have a $250 copay. Individual and group sessions for outpatient substance abuse have a copay of $25, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple (HMO-POS) plan, but requires prior authorization. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple (HMO-POS) plan. Ground and air ambulance services have a $300 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Wellcare Simple (HMO-POS) plan with a $125 copay, while Urgently Needed Services have a $40 copay; neither have coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $20 copay. This plan also covers physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services, all with varying copays.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services are covered, including Fitness Benefit, Alternative Therapies, and Remote Access Technologies, all with no 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. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids have a plan-specified amount per period maximum of $500 per ear, and prescription hearing aids (all types) are covered with no copay. Inner ear, outer ear, and over the ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
The Wellcare Simple (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams have a copay of $0-$20, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit coverage of $100 per year.
Dental Services See details
The Wellcare Simple (HMO-POS) plan covers a range of dental services, including oral exams, dental X-rays, and other diagnostic and preventive services with no copay. Medicare dental services have a $20 copay. Orthodontic services are covered up to a maximum of $3,000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare Simple (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO-POS) plan. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $20, lab services with no copay, diagnostic radiological services with a copay up to $300, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $75 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (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 technically covered, but none of the listed sub-services are covered by the Wellcare Simple (HMO-POS) plan. The listed sub-services include Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple (HMO-POS) plan, but require prior authorization. For days 1-20 and days 51-100, there is no copay, and 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
Other Services includes Over-the-Counter (OTC) Items and Meal Benefit, with 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 not covered. OTC items have no copay, and the plan offers a $71 benefit every three months. Meal Benefit has no copay and requires a doctor referral.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved