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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 IA. This plan received an overall rating of 2.5 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 $4400.00 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) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 select care drugs are highly affordable with no copay across all standard and preferred pharmacy or mail-order options. For brand-name and specialty medications, costs transition to a coinsurance model. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 35% coinsurance at preferred pharmacies and 36% coinsurance at standard pharmacies. Understanding these tier-based cost-sharing structures helps you estimate your out-of-pocket prescription costs with the Wellcare Simple (HMO-POS) plan.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers robust coverage with no copay and no coinsurance for primary care visits, routine preventive services, and home health care. Members also benefit from no copay and no coinsurance for routine dental, vision, and hearing services, which include annual allowances for eyewear and prescription hearing aids. Specialist visits and therapy services are highly affordable, requiring only a low copay of 25 dollars with no coinsurance. For major medical needs, inpatient hospital stays require a copay of 350 dollars or less for the first few days and no copay for subsequent days, while outpatient hospital services feature copays up to 300 dollars and no coinsurance. Emergency care is covered with a 130 dollar copay, and urgent care is available for a 25 dollar copay. Additionally, skilled nursing facility stays and diagnostic lab services feature no copay for standard services, making this plan a cost-effective option for overall healthcare management.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) inpatient hospital benefits are partially covered with no coinsurance, requiring a $350 copay for days 1 to 6 of acute stays (no copay for days 7 to 120) and a $325 copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Prior authorization is required, and upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Simple (HMO-POS) with no coinsurance, featuring outpatient hospital copays from $0 to $300 and observation services from $130 to $300 per stay. Ambulatory surgical center services require a $175 copay, outpatient substance abuse sessions have a $40 copay, and outpatient blood services are provided with no copay and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Wellcare Simple (HMO-POS) plan with a $140.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Wellcare Simple (HMO-POS), which features a $300 copay and no coinsurance for both ground and air ambulance services. Prior authorization is required, the copayment is not waived upon hospital admission, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Wellcare Simple (HMO-POS) with a $130 copay and no coinsurance, while urgent care is covered with a $25 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 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 and telehealth benefits with no copay and no coinsurance, while specialist visits require a $25 copay with no coinsurance. Physical, occupational, and speech therapies have a $20 copay with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) offers partially covered preventive services, including annual physicals, fitness benefits, and select screenings with no copay and no coinsurance, while kidney disease education has no copay but a 20% coinsurance. Multiple supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, weight management, therapeutic massage, and in-home support.
Hearing Services See details
Hearing services are partially covered by Wellcare Simple (HMO-POS), offering Medicare-covered exams for a $25 copay and no coinsurance, while routine annual exams, fittings, and prescription hearing aids have no copay and no coinsurance. Up to two prescription hearing aids are covered up to $1,000 per ear annually with prior authorization, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services under Wellcare Simple (HMO-POS) are partially covered with no copay and no coinsurance, though other eye exam services are not covered. The plan covers one routine eye exam annually and provides a $300 yearly allowance for eyewear—including contacts, eyeglasses, and upgrades—with no copay, no coinsurance, and prior authorization required.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), featuring no copay and no coinsurance for preventive and most comprehensive services, while Medicare-covered dental services require a $25 copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and there is a $3,000 annual maximum benefit for comprehensive services.
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 feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Simple (HMO-POS) 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, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $50 copay for diagnostic procedures under prior authorization. Covered radiological services also require prior authorization and feature copays starting at $0 for diagnostic radiology, a $35 copay with coinsurance for outpatient X-rays, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) provides cardiac rehabilitation services with no coinsurance, but in practice only some services are covered. Standard cardiac rehabilitation ($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 and do not require a prior three-day hospital stay, although prior authorization is required. 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 Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. A referral is required for the meal benefit, while acupuncture is not covered.
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