A non-government entity
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 $3400.00 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:
Sign up for Wellcare Simple (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple (HMO-POS) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using preferred pharmacies or preferred mail-order services. Additionally, Tier 6 select care drugs are highly accessible, featuring no copay across all standard and preferred pharmacy and mail-order options. Higher-tier medications under this plan require coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs both carry a 25% coinsurance, while Tier 4 non-preferred drugs require a 36% coinsurance across all pharmacy types. Standard pharmacies and standard mail orders are also available for generic tiers, with copays starting at $5 for a one-month supply of Tier 1 drugs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, while specialist visits require a low $20 copay. Emergency care has a $150 copay and urgent care visits are $25, with both fees waived if you are admitted to the hospital. For hospital stays, inpatient care features no coinsurance and a $275 copay for the first seven days of acute stays, after which there is no copay. Supplemental benefits under this plan include preventive dental, annual routine vision exams, and routine hearing tests with no copay or coinsurance. Members also receive up to $400 annually for eyewear, up to $500 per ear for prescription hearing aids, and over-the-counter items with no copay. Additionally, the plan covers up to 12 one-way transportation trips per year to approved health locations and home-delivered meals with no copay.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) partially covers inpatient hospital care with no coinsurance, requiring a $275 copay for days 1 to 7 of acute stays and a $225 copay for days 1 to 7 of psychiatric stays, with no copay for days 8 to 90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) outpatient services are covered with no coinsurance, featuring copays ranging from $0 to $280 for hospital services, $150 to $280 per stay for observation services, and $225 for ambulatory surgical center visits. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance per trip. The plan also covers up to 12 one-way transportation trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $150 copay and urgently needed services with a $25 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Chiropractic services are partially covered, excluding routine and other chiropractic services, podiatry is not covered, and other covered services like mental health and physical therapy require no coinsurance with copays ranging from $20 to $40.
Preventive Services See details
Wellcare Simple (HMO-POS) covers preventive services, including annual physical exams, fitness benefits, and select screenings, with no copay and no coinsurance. Kidney disease education is covered with no copay and 20% coinsurance, though certain supplemental services like health education and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Wellcare Simple (HMO-POS), offering routine hearing exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $20 copay and no coinsurance. Prescription hearing aids are partially covered up to $500 per ear yearly with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Wellcare Simple (HMO-POS), offering one annual routine eye exam and eyewear with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. Covered eyewear includes contact lenses, eyeglasses, frames, lenses, and upgrades, up to a combined maximum plan benefit of $400 per year.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), featuring a $20 copay and no coinsurance for Medicare-covered dental services. Preventive and most comprehensive dental benefits are offered with no copay and no coinsurance, though maxillofacial prosthetics 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 Part B to Part D step therapy may apply. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have 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
Medical equipment is covered by Wellcare Simple (HMO-POS) with prior authorization required. Durable medical equipment, prosthetics, and medical supplies are available with no copayment and a 20% coinsurance, while diabetic supplies have no copayment and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO-POS), offering lab services with no copay and no coinsurance, and diagnostic tests with a $0 to $30 copay and no coinsurance. Diagnostic radiological services start at a $0 copay, outpatient X-rays require a $25 copay, and therapeutic radiological services carry a minimum 20% coinsurance, with prior authorization required for these services.
Home Health Services See details
Home health services are covered under the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) covers cardiac rehabilitation services with no coinsurance, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copays ranging from $30 to $65.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, though additional days beyond the standard 100 days are not covered. Prior authorization is required, and patients pay no copay for days 1 to 20 and days 41 to 100, but must pay a $218 copay for days 21 to 40.
Other Services See details
Other Services under Wellcare Simple (HMO-POS) are partially covered, offering over-the-counter (OTC) items and home-delivered meals with no copay and no coinsurance. Acupuncture is not covered under this benefit, and a referral is required to receive the meal benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved