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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 2025, 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 out of 5 stars in 2025.
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 $31.40. 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 $570.00 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 $3600.00 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) plan has a $570.00 deductible. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier. For example, preferred generic drugs have a $19.00 copay at a preferred pharmacy. The plan has a specialty tier that has no copay, and it also offers a Part D premium reduction for those who qualify for the low-income subsidy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a $225 copay for days 1-9, and no copay for days 10-90. Outpatient services have copays that vary from $0 to $275, while ambulance services have a $275 copay. You can also expect no copay for primary care visits, preventive services, hearing exams and eyewear, and dental services. This plan also covers services like partial hospitalization, emergency services, and transportation with copays ranging from $25 to $140. Home health services, and skilled nursing facilities have no copay. In addition to these benefits, the plan includes coverage for home infusion, dialysis, medical equipment, diagnostic services, and other services, with varying copays and coinsurance percentages.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $225 copay for days 1-9 and no copay for days 10-90 for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute and Psychiatric, and Non-Medicare-covered stays for Inpatient Hospital-Acute and Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services are covered. Outpatient Hospital Services have a copay between $0 and $275, Observation Services have a copay between $140 and $275, Ambulatory Surgical Center (ASC) Services have a $150 copay, and Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Assist (HMO-POS) plan. Ground and air ambulance services have a $275 copay, while transportation services to a plan-approved health-related location have no copay and cover up to 24 one-way trips per year via rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered by the Wellcare Assist (HMO-POS) plan. Emergency Services have a $140 copay, Urgent Care services have a $25 copay, and both Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, and physical therapy and speech-language pathology services with a $25 copay. Mental health and psychiatric services, as well as Opioid Treatment Program services, have a $40 copay for individual and group sessions. Other health care professional services have a copay between $0 and $25. The plan also offers additional telehealth benefits with a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
Preventive Services include no copay for an annual physical exam, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Additional preventive services, including health education, in-home safety assessments, and more, are not covered.
Hearing Services See details
Wellcare Assist (HMO-POS) covers hearing exams with a $25 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids (all types) have no copay. Prescription hearing aids have a maximum plan benefit coverage of $500 per year.
Vision Services See details
The Wellcare Assist (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$25 and eyewear with no copay, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, up to a combined maximum of $200 per year. Routine eye exams have no copay and are covered once per year.
Dental Services See details
Dental services are covered, including Medicare dental services with a $25 copay, oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Orthodontic services have a maximum benefit of $2,000 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Assist (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered under the Wellcare Assist (HMO-POS) plan. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $20, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $225, and Outpatient X-Ray Services have a $50 copay. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist (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 Assist (HMO-POS) plan. Although the plan mentions that Cardiac Rehabilitation Services are covered, none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Assist (HMO-POS) plan, but require prior authorization. For days 1-20 and 41-100, there is no copay, and for days 21-40, the copay is $214. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. OTC items have no copay, and meal benefits have no copay.
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