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Wellcare Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Assist (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in LA. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Assist (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 Assist (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 Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.90. 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 $455.00 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 $4200.00 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 Assist (HMO-POS) prescription drug plan features an annual drug deductible of $455. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply at a preferred pharmacy. Beneficiaries can maximize savings by using preferred mail order, which offers no copay for a three-month supply of Tier 1 and Tier 2 medications. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry copays starting at $100. Tier 6 select care drugs are fully covered with no copay across all pharmacy and mail order options. These tiers provide structured options to manage your medication costs through preferred, standard, and mail-order services.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers comprehensive medical coverage with predictable costs, featuring no copay or coinsurance for primary care visits and routine preventive services. Specialist visits and urgent care require a low $25 copay, while emergency room visits carry a $150 copay with no coinsurance. For inpatient hospital stays, members pay a daily copay for the first nine days of care, followed by no copay for days 10 through 90. Members also benefit from robust dental, vision, and hearing coverage, including no copay for routine exams, a $2,000 annual dental limit, and a $200 eyewear allowance. The plan also covers up to 24 one-way transportation trips per year and home health services with no copay. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Assist (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1-9 of acute care and a $225 daily copay for days 1-9 of psychiatric care, followed by no copay for days 10-90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Assist (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from no copay to $300, alongside observation services with a $150 to $300 copay per stay. Ambulatory surgical center visits require a $250 copay, outpatient substance abuse sessions have a $40 copay, and outpatient blood services are available with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Wellcare Assist (HMO-POS) with a $175.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Assist (HMO-POS) covers ambulance services with a $275 copay and no coinsurance for ground and air transport. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Wellcare Assist (HMO-POS) covers emergency services with a $150 copay and urgently needed services with a $25 copay, with no coinsurance required for either service. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and opioid treatment require a $25 copay and no coinsurance. Mental health and psychiatric sessions have a $40 copay with no coinsurance, telehealth benefits range from no copay to a $40 copay, and chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Assist (HMO-POS) covers preventive services, offering annual physical exams, fitness benefits, alternative therapies, and remote access technologies with no copay and no coinsurance. Additional preventive services are partially covered, excluding options like health education, in-home safety assessments, and weight management. Kidney disease education requires no copay and a 20% coinsurance, while other services like glaucoma and diabetes screenings have no copay and no coinsurance.
Hearing Services See details
Hearing services are partially covered by Wellcare Assist (HMO-POS), offering Medicare-covered exams for a $25 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to $500 per ear annually, 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 Assist (HMO-POS), as other eye exam services are not covered. Covered benefits require no deductible and no coinsurance, featuring a $0 to $25 copay for eye exams (including no copay for one annual routine exam) and no copay for eyewear up to a $200 annual limit.
Dental Services See details
Wellcare Assist (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $25 copay and no coinsurance, and most preventive and comprehensive dental benefits with no copay and no coinsurance up to a $2,000 annual maximum. Prior authorization is required for most covered services, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Assist (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellcare Assist (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist (HMO-POS) covers 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 carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Assist (HMO-POS) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic tests with a $0 to $20 copay, while radiological services require a $50 copay for X-rays, a copay starting at $0 for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Wellcare Assist (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Assist (HMO-POS) provides coverage for Cardiac Rehabilitation Services with no coinsurance, though some services are covered while standard cardiac rehabilitation ($50 copay), intensive cardiac rehabilitation ($65 copay), pulmonary rehabilitation ($40 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($30 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Assist (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 41 to 100, while a daily copay of $218 applies for days 21 to 40.
Other Services See details
Wellcare Assist (HMO-POS) partially covers other services, providing over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan, and a referral is required to receive the meal benefit.
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