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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 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 TN. 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 $3800.00 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) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at preferred pharmacies and a $10 copay at standard pharmacies. For preferred brand drugs, you pay 41% coinsurance at preferred pharmacies, and 42% coinsurance at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a range of benefits with varying costs. This plan covers inpatient hospital stays with copays, and outpatient services with copays ranging from $0 to $325. You'll also find coverage for ambulance services with a $300 copay, and emergency services with a $140 copay. For primary care, specialist visits, and mental health services, the plan has copays of $0 to $40. Preventive services, hearing exams, and routine vision services are covered with no copay, while many dental services are covered with no copay. Additionally, the plan covers home health services, and skilled nursing facility stays, with varying copays depending on the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a $300 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $325, observation services with a copay between $140 and $325, ambulatory surgical center services with a $150 copay, and outpatient substance abuse services with a $40 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple (HMO-POS) plan, with a $130 copay, and requires prior authorization.
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. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Wellcare Simple (HMO-POS) plan with a $140 copay and no coinsurance, and urgently needed services have a $40 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $140 copay and no coinsurance, while 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 $15 copay, occupational therapy services with a $15 copay, and physician specialist services with a $15 copay. Mental health specialty services, including individual and group sessions, have a $40 copay. Other health care professional services have a copay between $0 and $15, while psychiatric services have a $40 copay for both individual and group sessions. Physical therapy and speech-language pathology services have a $15 copay. Additional telehealth benefits have a copay between $0 and $40, and Opioid Treatment Program Services have a $15 copay.
Preventive Services See details
The Wellcare Simple (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Other preventive services, such as kidney disease education services, have a 20% coinsurance. Other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The Wellcare Simple (HMO-POS) plan covers hearing exams with a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. The plan also covers prescription hearing aids, but does not cover inner ear, outer ear, and over the ear hearing aids, or OTC hearing aids.
Vision Services See details
The Wellcare Simple (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $15, and eyewear with no copay. Routine eye exams have no copay and are covered once per year, while eyewear has a combined maximum benefit of $300 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $15 copay, and Other Dental Services with no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable & fixed), and oral and maxillofacial surgery. Orthodontic Services are covered up to a maximum of $5,000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Simple (HMO-POS) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Diabetic Supplies have no copay and 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, including all diagnostic services, diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered. Diagnostic procedures/tests have a copay between $0 and $20, lab services have no copay, and outpatient X-rays have a $25 copay. Diagnostic Radiological Services have a copay of up to $325, while Therapeutic Radiological Services have a coinsurance of at least 20%.
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 covered by the Wellcare Simple (HMO-POS) plan, but the specific services listed are not covered. The plan mentions a copay, but does not provide any further details.
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, while days 21-50 have a $214 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits, with a $0 copay for OTC items. 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.
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