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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 2025, 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 LA. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $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 $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 Simple (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 you use. For preferred generic drugs, you'll pay no copay at preferred pharmacies or through mail order. For standard generic drugs, you'll pay 25% coinsurance, and for preferred brand drugs, you'll pay 38% coinsurance at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. This plan also covers primary care with no copay, along with specialist visits and therapies with copays. Additionally, you'll find coverage for preventive, hearing, vision, and dental services, with many services offered at no copay. This plan provides additional benefits such as ambulance and emergency services, along with coverage for home health and skilled nursing facilities. It also includes services for home infusion, dialysis, medical equipment, and diagnostic services, each with specific copays or coinsurance. Furthermore, the plan covers over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Wellcare Simple (HMO-POS) plan. For Inpatient Hospital-Acute, you will pay a $320 copay for days 1-10, and no copay for days 11-90, while Inpatient Hospital Psychiatric has a $225 copay for days 1-9, and no copay for days 10-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Wellcare Simple (HMO-POS) plan. Outpatient hospital services have a copay between $0 and $275, while observation services have a copay between $140 and $275. Ambulatory Surgical Center (ASC) Services have a $250 copay, and outpatient substance abuse services have a $40 copay per session. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple (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 Simple (HMO-POS) plan. Ground and Air Ambulance Services have a $275 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered under the Wellcare Simple (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $25 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $30 copay. The plan also covers physician specialist services with a $25 copay and physical therapy and speech-language pathology services with a $30 copay. Mental health specialty services and psychiatric services have a $40 copay for individual and group sessions, and other health care professionals have a copay between $0 and $25. The plan covers additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $25 copay. Podiatry services are not covered.
Preventive Services See details
The Wellcare Simple (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services may have a copay, but services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
The Wellcare Simple (HMO-POS) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but other prescription hearing aid types and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Simple (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$25, routine eye exams with no copay, and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. This plan offers a combined maximum benefit of $200.00 for all eyewear annually.
Dental Services See details
Dental services are covered under the Wellcare Simple (HMO-POS) plan. Medicare dental services have a $25 copay, while 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 have no copay. Orthodontic services have a maximum plan benefit of $3,000 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple (HMO-POS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
The Wellcare Simple (HMO-POS) plan covers Durable Medical Equipment (DME) with 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment are covered with 20% coinsurance for Medicare-covered Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts; Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests (with a copay between $0 and $30), lab services (no copay), all radiological services, diagnostic radiological services (with a copay up to $250), therapeutic radiological services (with at least 20% coinsurance), and outpatient X-ray services (with a $50 copay). Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple (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 covered by the Wellcare Simple (HMO-POS) plan, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-40, the copay is $214, and for days 41-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits, with no copay for either. 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.
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