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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 MO. 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 $6000.00 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 prescription drug deductible of $615. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, you can benefit from no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options are also available for these tiers, featuring low copays starting at $5 for a one-month supply. Higher-tier prescriptions on this plan transition to coinsurance, with Tier 3 preferred brands and Tier 5 specialty drugs requiring a 25% coinsurance. Tier 4 non-preferred drugs carry a 34% coinsurance at preferred pharmacies and a 35% coinsurance at standard pharmacies. Specialty drugs are limited to a one-month supply under this plan's drug coverage rules.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers strong medical coverage with predictable out-of-pocket costs, featuring no coinsurance for inpatient and outpatient hospital stays. Members benefit from no copay for primary care physician visits, while specialist visits require a $20 copay and no coinsurance. Emergency care is covered with a $130 copay and urgent care with a $45 copay, with no coinsurance required for either service. In addition to core medical care, this plan provides robust dental, vision, and hearing benefits with no copay and no coinsurance, including up to a $4,000 annual limit for dental services. Members also receive a $300 annual allowance for eyewear and up to $500 per ear annually for prescription hearing aids. Finally, home health services and over-the-counter items are covered with no copay and no coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. For acute stays, there is a $325 daily copay for days 1 to 9 and no copay for days 10 to 90, while psychiatric stays require a $300 daily copay for days 1 to 6 and no copay for days 7 to 90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under Wellcare Simple (HMO-POS) are covered with no coinsurance, featuring copays ranging from no copay to $400 for hospital outpatient services and $130 to $400 per stay for observation services. Ambulatory surgical center services require a $250 copay with no coinsurance, outpatient substance abuse sessions carry a $25 copay with no coinsurance, and outpatient blood services have no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Wellcare Simple (HMO-POS), with ground and air ambulance services requiring a $300 copay and no coinsurance, subject to prior authorization. While transportation is technically covered, some services are covered but transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and urgent care with a $45 copay, both with no coinsurance and copays waived if admitted within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 benefit limit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Other services such as therapy, psychiatric, and podiatry require copays ranging from $15 to $30 with no coinsurance, while chiropractic care is only partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive Services under Wellcare Simple (HMO-POS) are partially covered, offering no copay and no coinsurance for annual physical exams, fitness benefits, alternative therapies, and remote access technologies. Kidney disease education is covered with no copay and a 20% coinsurance, but several supplemental services like health education, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
Wellcare Simple (HMO-POS) hearing services are partially covered, offering Medicare-covered exams for a $20 copay and no coinsurance, plus routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services under the Wellcare Simple (HMO-POS) plan are partially covered, featuring no copay and no coinsurance for one routine eye exam per year, though other eye exam services are not covered. Eyewear benefits also have no copay or coinsurance, providing up to a $300 annual maximum for contacts and eyeglasses, with prior authorization required.
Dental Services See details
Wellcare Simple (HMO-POS) provides partially covered dental services, featuring Medicare-covered dental care for a $20 copay and no coinsurance, and preventive and comprehensive benefits with no copay and no coinsurance up to a $4,000 annual limit. 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 chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
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 medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, diabetic therapeutic shoes or inserts require a 20% coinsurance, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services, requiring prior authorization for most services. Members pay no copay and no coinsurance for lab and diagnostic radiological services, while diagnostic tests range from no copay to a $35 copay with no coinsurance, and outpatient X-rays require a $50 copay plus coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) offers Cardiac Rehabilitation Services with no coinsurance, meaning some services are covered but cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($35 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 to 20 and days 51 to 100, a $218 daily copay applies for days 21 to 50, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, providing over-the-counter items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan.
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