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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 LA. This plan received an overall rating of 3.5 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 $6300.00 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 plan features an annual prescription drug deductible of $615. You can save on medication costs with no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when filled at a preferred pharmacy or through preferred mail order. Tier 6 (Select Care Drugs) also feature no copay regardless of whether you use a preferred or standard pharmacy. For brand-name and specialty medications, costs are determined by coinsurance. Tier 3 (Preferred Brand) and Tier 5 (Specialty Tier) drugs require a 25% coinsurance, while Tier 4 (Non-Preferred Drugs) require a 39% coinsurance at preferred pharmacies and 40% coinsurance at standard pharmacies.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive healthcare coverage with predictable costs, featuring no copay for primary care doctor visits and home health services. Specialist visits require a $25 copay, while inpatient hospital stays have a $295 daily copay for days one through seven and no copay thereafter. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Supplemental benefits are a key highlight, offering routine dental, vision, and hearing exams with no copay, as well as allowances for eyewear and prescription hearing aids. Members also enjoy no copay on over-the-counter items and diagnostic lab services. While durable medical equipment and dialysis require a 20% coinsurance, most other covered services feature no coinsurance to keep your healthcare costs manageable.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 7 and no copay for days 8 through 90. Prior authorization is required, and certain services such as additional days, upgrades, 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 copays ranging from no copay to $275 for outpatient hospital services and a $250 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay, while outpatient blood services are fully covered with no copay and no deductible.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services under Wellcare Simple (HMO-POS) feature covered ground and air ambulance services with a $275 copay and no coinsurance, requiring prior authorization. Transportation services to plan-approved or health-related locations are not covered in practice.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, while worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) offers primary care physician visits with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Other covered services, such as physical therapy ($30 copay) and mental health sessions ($40 copay), feature no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes self-management, and select supplemental benefits like fitness and PERS. However, kidney disease education requires a 20% coinsurance with no copay, and several supplemental services, including health education, nutritional therapy, and in-home support, are not covered.
Hearing Services See details
Hearing services are partially covered under the Wellcare Simple (HMO-POS) plan, featuring a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Wellcare Simple (HMO-POS) because other eye exam services are not covered. Covered benefits have no deductible and no coinsurance, featuring one annual routine eye exam with no copay (up to a $25 copay for other covered exams) and eyewear with no copay up to a $200 yearly limit.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), with Medicare-covered dental requiring a $25 copay and no coinsurance, and preventive and comprehensive services offered with no copay and no coinsurance up to a $3,000 yearly limit. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are available with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
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 $30 copay for diagnostic tests. Covered radiological services require a $50 copay for outpatient x-rays, a 20% coinsurance for therapeutic radiological services, and no copay for diagnostic radiological services.
Home Health Services See details
Wellcare Simple (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Simple (HMO-POS) with no coinsurance, but some services are not covered, including cardiac rehabilitation (which has a $40 copay), intensive cardiac rehabilitation (with a $50 copay), pulmonary rehabilitation (with a $35 copay), and SET for PAD services (with a $25 copay).
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 51 through 100, a $218 daily copay for days 21 through 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 with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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