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Wellcare Patriot Giveback (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Patriot Giveback (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Patriot Giveback (HMO) in 2025, please refer to our full plan details page.
Wellcare Patriot Giveback (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 Patriot Giveback (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Patriot Giveback (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 Patriot Giveback (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $100.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7550.00 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
Prescription drugs are not covered by Wellcare Patriot Giveback (HMO).
Additional Benefits
The Wellcare Patriot Giveback (HMO) plan offers a range of benefits with varying costs. It includes coverage for inpatient and outpatient services, with copays depending on the specific service. Many services have no copay, such as primary care visits, home health services, and dental services. The plan also provides coverage for vision, hearing, and dental services, often with no copays or low copays. It includes coverage for prescription hearing aids up to $500 per year, and a combined maximum benefit of $200 per year for eyewear. Additionally, the plan covers home infusion, dialysis, and medical equipment with copays or coinsurance, as well as over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For Inpatient Hospital-Acute, you will pay a $345 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90. Additional days, non-Medicare covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a copay between $110 and $350, Ambulatory Surgical Center (ASC) Services with a $220 copay, Outpatient Substance Abuse Services with no copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Patriot Giveback (HMO) plan, with an $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Patriot Giveback (HMO) plan, with prior authorization required for all ambulance services. Medicare-covered ground and air ambulance services have a $260 copay, and there is no coinsurance. 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 copay of $110, $45, and $110 respectively, with no coinsurance. Worldwide Urgent Coverage also has a $110 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Patriot Giveback (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Occupational therapy services have a $30 copay, while specialist and physical therapy services have a $30 copay. Mental health and psychiatric individual and group sessions have no copay, and telehealth benefits have a copay between $0 and $45. Opioid treatment services have a $30 copay. Podiatry services are not covered.
Preventive Services See details
The Wellcare Patriot Giveback (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services have a copay, and kidney disease education services have a 20% coinsurance. Other services such as health education, in-home safety assessments, and several others are not covered.
Hearing Services See details
Wellcare Patriot Giveback (HMO) covers hearing exams with a $30 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 $500 per year and no copay for all types of prescription hearing aids for two visits per year, but inner ear, outer ear, and over the ear prescription 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 $30, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay. There is a combined maximum benefit of $200 per year for eyewear.
Dental Services See details
The Wellcare Patriot Giveback (HMO) plan covers dental services, including Medicare dental services with a $30 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Patriot Giveback (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying copays and coinsurance. Durable Medical Equipment for use outside of the home is not covered. Diabetic Supplies have no copay. Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and lab services with no copay, while diagnostic radiological services have a copay of up to $350.00 and outpatient x-ray services have a $25 copay. Therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Wellcare Patriot Giveback (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Patriot Giveback (HMO) plan. The plan does not cover 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20 and 61-100, there is no copay, and for days 21-60, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum benefit of $65 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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