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Wellcare Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Assist (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 Assist (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 Assist (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 Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. 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 $475.00 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 $5500.00 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 Assist (HMO-POS) Medicare plan features an annual prescription drug deductible of $475. You will pay no copay for Tier 6 select care drugs across all standard or preferred pharmacies and mail-order options. Tier 1 preferred generic and Tier 2 generic drugs also feature no copay when ordering a three-month supply through preferred mail order, though standard short-term fills carry copays ranging from $18 to $20. For higher-tier medications, Tier 3 preferred brand drugs and Tier 5 specialty tier drugs require a 25% coinsurance. Tier 4 non-preferred drugs have a flat copay, starting at $100 for a one-month supply and going up to $300 for a three-month supply. Using preferred pharmacies and preferred mail order generally yields the greatest savings on your prescription drug costs.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers strong coverage with many opportunities for no-cost care, including no copays or coinsurance for primary care visits, preventive services, home health care, and routine dental exams. Members also benefit from no copays for routine vision and hearing exams, which include up to a $400 annual eyewear allowance and up to $750 per ear for prescription hearing aids. Additionally, up to 12 one-way transportation trips per year to plan-approved locations are covered with no copay. For other medical needs, specialist office visits require a low $15 copay, while emergency room care has a $130 copay. Inpatient hospital stays require a daily copay for the first several days but feature no copay for longer stays, and skilled nursing facility stays have no copay for the first 20 days. Diagnostic lab tests are covered with no copay, though services like durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
Wellcare Assist (HMO-POS) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $450 daily copay for days 1 to 6 and no copay for days 7 to 100, while psychiatric care requires a $375 daily copay for days 1 to 5 and no copay for days 6 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the Wellcare Assist (HMO-POS) plan with no coinsurance, though copays vary by service and prior authorization may be required. Members will pay a $0 to $300 copay for outpatient hospital facility visits, a $250 copay for ambulatory surgical center services, a $30 copay for outpatient substance abuse sessions, and no copay or deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Assist (HMO-POS) with a $140.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellcare Assist (HMO-POS) covers ground and air ambulance services with a $295 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, while transportation to any other health-related locations is not covered.
Emergency Services See details
Emergency services under Wellcare Assist (HMO-POS) are covered with a $130 copay and no coinsurance, while urgently needed services require a $50 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO-POS) offers primary care physician visits with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Therapy services require a $25 copay and no coinsurance, while mental health sessions have a $30 copay and no coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered under Wellcare Assist (HMO-POS), with covered benefits like annual physicals, alternative therapies, memory fitness, and remote access technologies requiring no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Sub-services that are not covered include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Wellcare Assist (HMO-POS), featuring a $15 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. Prescription hearing aids are covered up to $750 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Wellcare Assist (HMO-POS) with no deductible, offering one annual routine eye exam with no copay and no coinsurance, though other eye exam services are not covered. Covered eyewear also features no copay and no coinsurance, providing up to a $400 annual maximum benefit for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by Wellcare Assist (HMO-POS), offering Medicare-covered dental care for a $15.00 copay and no coinsurance, alongside preventive and comprehensive services with no copay and no coinsurance. While most dental needs are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Assist (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Assist (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under Wellcare Assist (HMO-POS) with prior authorization, featuring no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts are subject to a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Assist (HMO-POS) with prior authorization, featuring no copay and no coinsurance for lab services and diagnostic procedures. Diagnostic radiological services also have no copay, while outpatient X-rays require a $25 copay and therapeutic radiological services incur a 20% coinsurance.
Home Health Services See details
Home health services are covered under the Wellcare Assist (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Assist (HMO-POS) plan, as no coverage is provided for cardiac, intensive cardiac, pulmonary, or supervised exercise therapy (SET) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Wellcare Assist (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required. There is no copay for days 1 to 20 and days 51 to 100, while days 21 to 50 require a $218 daily copay.
Other Services See details
Wellcare Assist (HMO-POS) offers partial coverage for other services, providing over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though meals require a referral. Acupuncture is not covered under this benefit.
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