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Wellcare Assist (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO) in 2025, please refer to our full plan details page.
Wellcare Assist (HMO) is a HMO plan offered by Centene Corporation available for enrollment in 2025 to people living in Statewide in PA. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Assist (HMO) 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).
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), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.20. 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 $490.00 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 $5200.00 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) plan has a $490 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $19 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, the plan's premium will be $30.20.
Additional Benefits
The Wellcare Assist (HMO) plan offers a wide range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay for the first few days, with no copay thereafter. Outpatient services, including primary care, have copays, while preventive services like annual checkups are covered with no copay. This plan also includes coverage for hearing, vision, and dental services, often with no copay or low copays, as well as coverage for ambulance, emergency, and skilled nursing facility services. Additional benefits include coverage for over-the-counter items, home health services, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $450 copay for days 1-5 and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you'll pay a $375 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-100. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for Wellcare Assist (HMO) includes coverage for Outpatient Hospital Services with a copay between $0 and $300, Observation Services with a copay between $125 and $300, Ambulatory Surgical Center Services with a $250 copay, and Outpatient Substance Abuse Services with a $30 copay for both Individual and Group Sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist (HMO) plan, but requires prior authorization. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Assist (HMO) plan. Ground and air ambulance services have a $295 copay, and transportation services to a plan-approved health-related location have no copay for up to 12 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $25 copay, and physician specialist services with a $25 copay. Mental health specialty services, including individual and group sessions, have a $30 copay, while physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay between $0 and $55, and opioid treatment program services have a $25 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and an annual physical exam with no copay. Additional preventive services are covered, including 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
Wellcare Assist (HMO) covers hearing exams with a $25 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are covered with a maximum benefit of $1,000 per year, but inner, outer, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit of $400 per year.
Dental Services See details
Wellcare Assist (HMO) covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery, all with no copay. Medicare dental services have a $25 copay. Orthodontic services are covered up to a maximum of $5,000 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Assist (HMO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Assist (HMO) plan. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with coinsurance and copay details provided below. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellcare Assist (HMO) plan. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of up to $300, and Outpatient X-Ray Services have a $25 copay. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist (HMO) 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 under the Wellcare Assist (HMO) plan, but the plan does not cover the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation 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 by the Wellcare Assist (HMO) plan. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60; there is no coinsurance.
Other Services See details
The Wellcare Assist (HMO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $138.00 every three months. The plan also covers a Meal Benefit with no copay, and requires a doctor referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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