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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.
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 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
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 $5500.00 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 (HMO-POS) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 select care drugs are available with no copay across all standard and preferred pharmacies. For higher-tier medications, costs shift to a coinsurance percentage rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 33% to 34% coinsurance. Standard pharmacies and standard mail-order services are also available for generic tiers, with copays ranging from $5 to $30 depending on the supply duration.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage with predictable cost-sharing, featuring no copays or coinsurance for primary care physician visits and most preventive services. Specialist visits require a low $15 copay, while emergency room care carries a $130 copay that is waived if you are admitted to the hospital. Inpatient hospital stays require a $250 copay for days one through eight, with no copay for days nine through ninety-five. Members benefit from robust supplemental care, including dental services up to a $4,000 annual maximum and routine vision care with a $400 annual eyewear allowance, both with no copays or coinsurance. Additionally, the plan offers no copays for routine hearing exams, up to $500 per ear annually for prescription hearing aids, and up to 12 one-way transportation trips per year to plan-approved locations. Essential services like home health care have no copay, while durable medical equipment and dialysis require a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Wellcare Simple (HMO-POS) with no coinsurance, though prior authorization is required. For acute care, there is a $250 copay for days 1 through 8 and no copay for days 9 through 95, while psychiatric stays require a $275 copay for days 1 through 6 and no copay for days 7 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services with no coinsurance, featuring a copay of $0 to $300 for outpatient hospital services and $250 for ambulatory surgical center services. Outpatient substance abuse sessions have a $25 copay and no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization benefits with a $140.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $40 copay, both with no coinsurance and with copays waived if you are 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, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) primary care benefits feature primary care physician visits with no copay and no coinsurance, while specialist visits require a $15 copay and no coinsurance. Physical, occupational, and speech therapy services require a $20 copay with no coinsurance, and mental health services carry a $25 copay with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Wellcare Simple (HMO-POS), with most covered services like annual physicals, fitness benefits, and screenings requiring no copay and no coinsurance, while kidney disease education carries a 20% coinsurance and no copay. Excluded services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Wellcare Simple (HMO-POS) with no coinsurance, requiring a $15 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 or coinsurance, though OTC hearing aids and specific prescription types—including inner ear, outer ear, and over the ear models—are not covered.
Vision Services See details
Vision services through Wellcare Simple (HMO-POS) are partially covered, offering one routine eye exam per year with no copay and no coinsurance, while other eye exam services are not covered. Covered eyewear has no copay or coinsurance up to a $400 annual limit, with no deductibles applying to any vision services.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and comprehensive services up to a $4,000 annual maximum. Prior authorization is required for most services, and 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, though prior authorization and step therapy may apply. Under this plan, covered Medicare Part B insulin has a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services, both of which require prior authorization. Diagnostic services carry no coinsurance, featuring no copay for lab work and a $0 to $20 copay for diagnostic procedures, while radiological services include a $45 copay for outpatient X-rays, diagnostic radiology starting at no copay, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Wellcare Simple (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) indicates some services are covered with no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. These non-covered services require copays of $40, $50, $35, and $25 respectively.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Simple (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is 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 Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Simple (HMO-POS), offering over-the-counter (OTC) items and limited-duration meal benefits with no copay and no coinsurance, though a referral is required for meals. Acupuncture and other additional services are not covered under this benefit.
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