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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 $5900.00 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 meeting the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. For specialty drugs, you will pay no copay at any pharmacy.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a variety of additional benefits beyond standard Medicare coverage. This plan includes coverage for inpatient hospital stays with copays, outpatient services with varying copays, and mental health services. Other benefits include hearing, vision, and dental services, with copays or coinsurance applying to certain services. The plan also provides coverage for ambulance and transportation, emergency services, and preventive services with no or low copays.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Wellcare Simple (HMO-POS) plan. For acute care, you pay a $275 copay for days 1-9 and no copay for days 10-90; for psychiatric care, you pay a $225 copay for days 1-9 and no copay for days 10-90. Additional days and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $280, observation services have a copay between $125 and $280, ambulatory surgical center services have a $250 copay, and outpatient substance abuse services have a $40 copay for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple (HMO-POS) plan, with a $105 copay. Prior authorization is required for this benefit.
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, and transportation services to a plan-approved health-related location have no copay for up to 12 one-way trips per year, using rideshare, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services with the Wellcare Simple (HMO-POS) plan include a $125 copay, and no coinsurance. Urgently Needed Services have a $25 copay, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and no coinsurance. 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, occupational therapy services with a $40 copay, physician specialist services with a $25 copay, and physical therapy and speech-language pathology services with a $40 copay. This plan also covers mental health and psychiatric services with a $40 copay for individual and group sessions, other health care professional services with a copay between $0 and $25, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $25 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include Medicare-covered zero dollar services and an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Remote Access Technologies, Alternative Therapies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing Services include coverage for 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, and are limited to a maximum of $350 per year, per ear. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and neither are OTC hearing aids.
Vision Services See details
The Wellcare Simple (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $25, and eyewear with no copay. Routine eye exams are covered with no copay for one exam per year, while eyewear has a combined maximum plan benefit coverage of $200 per year.
Dental Services See details
The Wellcare Simple (HMO-POS) plan covers dental services, including oral exams and dental x-rays with no copay, and other diagnostic and preventive services with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with 20% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Simple (HMO-POS) plan. 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 Simple (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered under the Wellcare Simple (HMO-POS) plan, including durable medical equipment with a 20% coinsurance and prosthetics, medical supplies, and diabetic equipment. Durable medical equipment for use outside the home is not covered. Diabetic supplies have no copay, while diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, are covered with a copay of $0-$30 for Diagnostic Procedures/Tests and no copay for Lab Services. Radiological Services include a copay of up to $250 for Diagnostic Radiological Services and a 20% coinsurance for Therapeutic Radiological Services, while Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by 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, but the plan does not cover any of the listed sub-services. There is a copay for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Simple (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60. Additional days beyond Medicare-covered SNF stays, and non-Medicare-covered SNF stays 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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