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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 2025, please refer to our full plan details page.
Wellcare Giveback (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 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 $86.00. You must continue to pay paying your reduced 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 $6700.00 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 Giveback (HMO-POS) plan has a $420.00 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and where you fill your prescription. For preferred generic drugs, you will pay no copay at preferred pharmacies or via mail order, and a $10 copay at standard pharmacies. Standard generic drugs have 25% coinsurance, preferred brand drugs have 50% coinsurance, and non-preferred drugs have 28% coinsurance. The specialty tier drugs have no copay.
Additional Benefits
The Wellcare Giveback (HMO-POS) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, emergency services, and various doctor visits with copays. Preventative services such as annual physical exams are covered with no copay. The plan also covers hearing, vision, and dental services. This plan provides coverage for home health services, durable medical equipment, and diagnostic services with copays or coinsurance. Ambulance services, skilled nursing facilities, and home infusion are also covered under this plan, with copays and coinsurance varying by service. However, some services like cardiac rehabilitation, and other services like acupuncture, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-7 and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $1600 copay per admission or stay. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a copay between $125 and $350, Ambulatory Surgical Center (ASC) Services with a $175 copay, Individual and Group Sessions for Outpatient Substance Abuse with a $40 copay, and Outpatient Blood Services with no copay. Prior authorization is required for some of these services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Giveback (HMO-POS) plan, with a $105 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Giveback (HMO-POS) plan. Both ground and air ambulance services have a $275 copay, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Giveback (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services have a $35 copay; all three have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Giveback (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $40 copay, physician specialist services with a $50 copay, and mental health specialty services with a $40 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a copay between $0 and $50, and Opioid Treatment Program Services with a $50 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services, some of which have a copay. Kidney disease education services have a 20% coinsurance. Other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, 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
The Wellcare Giveback (HMO-POS) plan covers hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
The Wellcare Giveback (HMO-POS) plan covers vision services including eye exams with a copay between $0 and $50, and eyewear with no copay. Routine eye exams are covered with no copay, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
The Wellcare Giveback (HMO-POS) plan covers Medicare Dental Services with a $50 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. However, restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay. The plan covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Giveback (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
The Wellcare Giveback (HMO-POS) plan covers Durable Medical Equipment with 20% coinsurance and no copay, and covers Prosthetics/Medical Supplies with 20% coinsurance and no copay. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Giveback (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $350, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback (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 not covered by the Wellcare Giveback (HMO-POS) plan. Although the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Giveback (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60. Additional days beyond Medicare coverage, and non-Medicare-covered stays, are not covered.
Other Services See details
Other Services are not covered under the Wellcare Giveback (HMO-POS) plan, including acupuncture, over-the-counter items, meal benefits, and more. No authorization or referral is required for these services.
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