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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 TN. 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 $4800.00 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 features an annual drug deductible of $615. Beneficiaries can 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 across all standard and preferred pharmacy and mail order options. For brand-name and specialty medications, the plan utilizes coinsurance, with Tier 3 (Preferred Brand) and Tier 5 (Specialty) drugs requiring a 25% coinsurance. Tier 4 (Non-Preferred) drugs carry a 35% coinsurance at preferred locations and a 36% coinsurance at standard locations. Standard pharmacies also charge copays ranging from $5 to $30 for Tier 1 and Tier 2 generic drugs depending on the supply.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, including no copays for primary care physician visits and a $15 copay for specialist appointments. For hospital care, members pay no coinsurance, with inpatient acute stays requiring a $350 copay for the first six days and outpatient hospital services ranging from no copay up to a $325 copay. Emergency room visits carry a $130 copay, while urgent care services require a $40 copay, with no coinsurance for either service. This plan also includes valuable supplemental coverage, featuring no copays for routine dental, vision, and hearing exams, alongside a $5,000 annual maximum for dental care and a $300 annual allowance for eyewear. Home health services and diabetic supplies are fully covered with no copays, while durable medical equipment and dialysis require a 20% coinsurance. Additionally, skilled nursing facility stays are highly affordable, requiring no copays for the first 20 days of care.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $350 copay for days 1 to 6 of acute stays and a $300 copay for days 1 to 6 of psychiatric stays, with no copays for remaining covered days. Prior authorization is required, and upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services with no coinsurance, featuring copays of $0 to $325 for outpatient hospital services, $130 to $325 per stay for observation services, and $150 for ambulatory surgical center visits. Outpatient substance abuse sessions require a $40 copay, 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 services with a $140.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) partially covers ambulance and transportation services, offering ground and air ambulance services for a $300 copay and no coinsurance with prior authorization. Transportation services to plan-approved or any other health-related locations 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 copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered with a $130 copay, no coinsurance, and a $50,000 maximum benefit, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) primary care benefits feature no copay and no coinsurance for primary care physician visits, while specialist visits, therapy services, and opioid treatment require a $15 copay with no coinsurance. Mental health, psychiatric, and telehealth services carry copays ranging from $0 to $40 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under Wellcare Simple (HMO-POS) are partially covered, featuring no copay and no coinsurance for annual physicals, fitness benefits, remote access, alternative therapies, and routine screenings, while kidney disease education has a 20% coinsurance and no copay. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home and bathroom safety, and counseling.
Hearing Services See details
Wellcare Simple (HMO-POS) covers hearing services, featuring a $15 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear annually, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) vision services are partially covered with no deductibles, featuring no coinsurance and a $0 to $15 copay for eye exams, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $300 combined annual maximum for contact lenses, eyeglasses, frames, lenses, and upgrades.
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 other covered preventive and comprehensive services up to a $5,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Wellcare Simple (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic services with no coinsurance, featuring a $0 to $20 copay for tests and no copay for lab services. For radiological services, diagnostic radiology has no copay, outpatient X-rays require a $25 copay, and therapeutic radiology has a 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
Cardiac rehabilitation services are covered by Wellcare Simple (HMO-POS) with no coinsurance, but only some services are covered. Specifically, standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Simple (HMO-POS) with no coinsurance, requiring no copay for days 1 to 20 and 51 to 100, and a $218 daily copay for days 21 to 50. Prior authorization is required and a prior three-day hospital stay is not needed, though additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires a referral.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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