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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 PA. 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 $6200.00 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 features an annual prescription drug deductible of $615. Beneficiaries can save on medications with no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when filled through preferred pharmacies or preferred mail-order services. Additionally, Tier 6 (Select Care Drugs) are highly accessible with no copay at both preferred and standard pharmacies. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 (Preferred Brand) and Tier 5 (Specialty) drugs both carry a 25% coinsurance, though specialty drugs are limited to a one-month supply. Tier 4 (Non-Preferred) drugs require a 35% coinsurance at preferred pharmacies or a 36% coinsurance at standard pharmacies.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive coverage with predictable costs, featuring no copay and no coinsurance for primary care visits and routine preventive services. Specialist visits require a low $20 copay, while inpatient hospital stays incur a $300 daily copay for the first seven days and no copay for subsequent days up to day ninety. Emergency care is accessible with a $130 copay, and urgent care visits require a $40 copay, both with no coinsurance. This plan also provides strong auxiliary benefits, including preventive and comprehensive dental care with no copay up to a $5,000 annual limit. Routine vision and hearing exams are available with no copay, complemented by a $400 annual eyewear allowance and a $500 yearly hearing aid benefit per ear. For durable medical equipment and dialysis services, members will generally pay no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 7 and no copay for days 8 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) outpatient services are covered with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $275 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple (HMO-POS) with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $250 copay and no coinsurance, subject to prior authorization. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $40 copay, both featuring no coinsurance and cost-sharing that does not apply to the deductible. Worldwide emergency services are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) offers primary care provider services with no copay and no coinsurance, alongside specialist visits with a $20 copay and no coinsurance. Covered therapy services require a $15 copay and no coinsurance, mental health sessions have a $25 copay and no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) preventive services are partially covered, offering annual physicals, alternative therapies, fitness benefits, remote access, glaucoma screenings, and diabetes training with no copay and no coinsurance, and kidney disease education with no copay and 20% coinsurance. Excluded from coverage are health education, in-home safety assessments, personal emergency response systems, 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, tobacco cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Wellcare Simple (HMO-POS) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $500 per ear yearly, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) provides partially covered vision services, offering one annual routine eye exam and up to $400 for eyewear per year with no copay and no coinsurance. Other eye exam services are not covered, and prior authorization is required for covered exams and eyewear.
Dental Services See details
Wellcare Simple (HMO-POS) provides partially covered dental services, which include Medicare-covered dental with a $20 copay and no coinsurance, as well as preventive and comprehensive services with no copay and no coinsurance up to a $5,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may be required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Wellcare Simple (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are also covered with no copay, though prior authorization is required and brand limitations apply.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services with prior authorization, offering diagnostic tests, lab services, and diagnostic radiology with no copay and no coinsurance. Outpatient X-rays require a $50 copay, while therapeutic radiological services incur a minimum 20% coinsurance.
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 not covered under Wellcare Simple (HMO-POS), as all sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy (SET) services—are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and 51 to 100, and a $218 daily copay for days 21 to 50. Prior authorization is required, 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, while acupuncture and meal benefits are not covered. Covered OTC items are delivered via reimbursement and include nicotine replacement therapy and naloxone with no maximum plan benefit limit.
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