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Wellcare Endurance (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Endurance (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Endurance (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Endurance (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 Endurance (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 Endurance (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 Endurance (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 $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 Endurance (HMO-POS) plan has a $420 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay no copay at preferred pharmacies or preferred mail order, and a $10 copay at standard pharmacies and standard mail order. For specialty tier drugs, you'll pay no copay at any pharmacy.
Additional Benefits
The Wellcare Endurance (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including primary care, often have copays, which vary by service. Many preventive services have no copay, and the plan also includes coverage for hearing, vision, and dental services, with some services having no copay. The plan provides coverage for ambulance and transportation services, emergency services, and home health services with no copay. Additionally, the plan covers home infusion and dialysis services with coinsurance, while durable medical equipment and prosthetic devices have a 20% coinsurance. Other benefits include no copay for over-the-counter items and meal benefits with a doctor's referral.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $350 per day for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $300 per day for days 1-7 and no copay for days 8-90 for Inpatient Hospital Psychiatric. Additional days, non-Medicare-covered stays, and upgrades for 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 ranging from $0 to $400, observation services with a copay between $125 and $400, and ambulatory surgical center services with a $250 copay. Outpatient substance abuse services have a copay of $40 for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Wellcare Endurance (HMO-POS) covers partial hospitalization with a $105 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Endurance (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, with a limit of 12 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a $125 copay, and Worldwide Urgent Coverage has a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Endurance (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay. The plan also covers physician specialist services with a $25 copay, and physical therapy and speech-language pathology services with a $40 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, and opioid treatment program services are covered with varying copays depending on the service. Additional telehealth benefits are covered with a copay between $0 and $40.
Preventive Services See details
Preventive Services include annual physical exams with no copay, and additional preventive services with a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services include no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit.
Hearing Services See details
The Wellcare Endurance (HMO-POS) plan covers hearing exams with a $25 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to $350 per ear every year, with no copay for prescription hearing aids (all types). Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
The Wellcare Endurance (HMO-POS) plan covers vision services including eye exams and eyewear. Eye exams have a copay of $0-$25, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay. There is a combined maximum benefit of $200 for all eyewear, every year.
Dental Services See details
The Wellcare Endurance (HMO-POS) plan covers Medicare Dental Services with a $25 copay, and other dental services like oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay. Orthodontic services are covered up to a $1000 maximum, while prosthodontics (removable and fixed), 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. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Endurance (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Endurance (HMO-POS) plan. Durable Medical Equipment (DME) and Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a 20% coinsurance and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $30, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $75 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Endurance (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 Endurance (HMO-POS) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Endurance (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, a $214 copay for days 21-40, and no copay for days 41-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under Other Services, 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. Over-the-counter (OTC) items are covered with no copay, and a maximum benefit of $31.00 every three months. Meal benefits are covered with no copay and require a doctor's referral.
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