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Wellcare Giveback (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback (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 Giveback (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 TN. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Giveback (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 Giveback (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 Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $81.00. You must continue to pay paying your reduced 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 $6700.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6700.00 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 Giveback (HMO-POS) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, members can save significantly by paying no copay at preferred pharmacies and preferred mail order services. Standard pharmacies and standard mail order options are also available with low copays ranging from $5 to $30 depending on the drug tier and supply. For higher-tier medications, the plan utilizes coinsurance to determine your out-of-pocket expenses. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs have a 50% coinsurance. These coinsurance rates apply across both preferred and standard pharmacies, making it easy to calculate your costs for brand-name and specialty prescriptions.
Additional Benefits
The Wellcare Giveback (HMO-POS) plan offers robust coverage for essential medical services with predictable out-of-pocket costs and no coinsurance for many key benefits. Members enjoy no copay and no coinsurance for primary care visits, preventive care, and home health services, while specialist visits require a $45 copay. Inpatient hospital stays carry a $350 daily copay for the first seven days followed by no copay for additional days, and emergency room visits feature a $130 copay. For supplemental care, the plan provides routine dental, vision, and hearing exams with no copay, alongside allowances for eyewear and hearing aids. Medicare-covered dental and hearing exams require a $45 copay, while durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance. This plan balances low copays for routine care with structured costs for specialized medical needs.
Inpatient Hospital See details
Wellcare Giveback (HMO-POS) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, there is a $350 daily copay for days 1 to 7 and no copay for days 8 to 90, while psychiatric care requires a $1,600 copay per stay. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Giveback (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $130 to $350 copay per stay for observation services. Ambulatory surgical center services require a $175 copay, outpatient substance abuse sessions cost a $40 copay, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Wellcare Giveback (HMO-POS) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO-POS) covers Medicare-approved ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Giveback (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $35 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent services 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 Giveback (HMO-POS) offers primary care physician visits with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with a $40 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Giveback (HMO-POS) covers standard Medicare preventive services, annual physical exams, and select screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Additional benefits like fitness programs, remote access technologies, and alternative therapies are covered with no copay and no coinsurance, but other supplemental services including health education, weight management, and nutritional benefits are not covered.
Hearing Services See details
Wellcare Giveback (HMO-POS) provides partially covered hearing services, featuring a $45 copay and no coinsurance or deductible for Medicare-covered exams, and annual routine exams with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Giveback (HMO-POS), featuring eye exams with a $0 to $45 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $100 annual limit, and prior authorization is required for these benefits.
Dental Services See details
Wellcare Giveback (HMO-POS) offers partially covered dental services, featuring Medicare-covered dental at a $45 copay and no coinsurance, and preventive care like exams and cleanings with no copay and no coinsurance. However, major services such as restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Giveback (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 requires a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Giveback (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Giveback (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance and are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Giveback (HMO-POS) with prior authorization required, featuring no coinsurance and no copay for lab services. Outpatient diagnostic procedures have a copay of $0 to $20, diagnostic radiological services have a minimum copay of $0, outpatient X-rays require a $25 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Wellcare Giveback (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under Wellcare Giveback (HMO-POS), but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Giveback (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and days 61 to 100, and a $218 daily copay for days 21 to 60. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Giveback (HMO-POS) provides coverage for other services where some services are covered, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered. Since these sub-services are not covered by the plan, there is no copay or coinsurance available, and members are responsible for the full cost of these services.
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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