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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 $5000.00 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. Under this plan, you will pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using preferred pharmacies or preferred mail order services. Standard pharmacy and mail order options for Tier 1 and Tier 2 generic drugs require small copays ranging from $5 to $30. Higher-tier medications require coinsurance instead of flat copays, with Tier 3 preferred brands and Tier 5 specialty drugs requiring a 25% coinsurance. Tier 4 non-preferred drugs carry a 35% coinsurance across all pharmacy networks. Specialty tier medications are covered at 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a $20 copay, while inpatient hospital stays carry a $295 daily copay for acute days 1 through 7 and no copay for days 8 through 90. Emergency care is available with a $130 copay, and outpatient services feature no coinsurance with outpatient hospital copays ranging from no copay up to $280. For supplemental benefits, the plan covers preventive and comprehensive dental services with no copay up to a $4,000 annual limit. Routine vision and hearing exams also require no copay, with allowances of up to $500 per ear for hearing aids and $100 annually for eyewear. Durable medical equipment and dialysis require a 20% coinsurance with no copay, while skilled nursing facility stays require no copay for days 1 through 20.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Simple (HMO-POS), as upgrades, additional days, and non-Medicare-covered stays are not covered. Covered acute stays require a $295 copay for days 1 through 7 and no copay for days 8 through 90, while psychiatric stays require a $275 copay for days 1 through 7 and no copay for days 8 through 90, with no coinsurance required for either.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services with no coinsurance, featuring a copay of $0 to $280 for outpatient hospital services and $225 for ambulatory surgical center services. Additionally, outpatient substance abuse services require a $40 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellcare Simple (HMO-POS) with a $140.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
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 copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum benefit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $20 copay and therapy services cost $35. Mental health, psychiatric, and telehealth services have copays up to $40 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) covers annual physicals, preventive screenings, and select wellness benefits with no copay and no coinsurance, though kidney disease education has a 20% coinsurance and no copay. Additional preventive benefits are partially covered with no copay or coinsurance, excluding health education, in-home safety, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Wellcare Simple (HMO-POS) offers partially covered hearing services with no deductible, requiring a $20 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and hearing aid fittings. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC hearing aids and prescription inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) partially covers vision services, offering eye exams with a $0 to $20 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $100 annual maximum, with prior authorization required for services.
Dental Services See details
Wellcare Simple (HMO-POS) covers dental services with a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and covered comprehensive services up to a $4,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple (HMO-POS) with no copay, although prior authorization and step therapy may apply. Under this benefit, Medicare Part B chemotherapy and other drugs have a 0% to 20% coinsurance and no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic therapeutic shoes, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, although brand limits apply, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services with prior authorization required, offering lab services with no copay or coinsurance and diagnostic tests with no coinsurance and a $0 to $30 copay. Diagnostic radiological services have a $0 minimum copay, outpatient X-rays require a $25 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) offers cardiac rehabilitation services with no coinsurance, though in practice only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. These non-covered services require copayments ranging from $25 to $50.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers skilled nursing facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and days 51 through 100, and a $218 daily copay for days 21 through 50. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) provides partially covered other services, which include over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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