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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 Statewide - Indiana. This plan received an overall rating of 3 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 $4200.00 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 drug deductible of $615. For prescription savings, this plan offers no copay for Tier 1 preferred generics and Tier 2 generics when filled at a preferred pharmacy or through preferred mail order. Select Care drugs in Tier 6 also feature no copay across all pharmacy and mail-order options, while standard pharmacies charge low copays starting at $5 for Tier 1 and $10 for Tier 2 drugs. Tier 3 preferred brands and Tier 5 specialty drugs both carry a 25% coinsurance, while Tier 4 non-preferred drugs require a 36% coinsurance at preferred network locations and 37% at standard locations. These structured tiers allow you to estimate your prescription expenses and maximize savings by using preferred pharmacies.
Additional Benefits
The Wellcare Simple (HMO-POS) plan focuses on affordability by offering many essential medical services with no coinsurance and predictable copayments. You will pay no copay for primary care visits, while specialist visits require a $25 copay and inpatient hospital stays carry a $350 daily copay for the first six days. Outpatient hospital services, emergency care, and urgent care are also covered with fixed copays and no coinsurance, helping you manage your healthcare budget. For everyday wellness, the plan provides robust coverage for preventive services, routine vision exams, and dental care with no copay or coinsurance. Dental benefits feature a $3,000 annual limit, while prescription hearing aids are covered up to $1,000 per ear annually and routine eyewear includes a $300 yearly allowance. Additionally, members can access over-the-counter items and up to 12 one-way transportation trips per year with no copay.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 to 6 and no copay for days 7 to 90. Prior authorization is required, and specific sub-services such as hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from no copay up to $350 for hospital services, $150 to $350 per stay for observation services, and $250 for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellcare Simple (HMO-POS) with a $175.00 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 $300 copay and no coinsurance, requiring 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, while transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $150 copay and urgently needed services with a $35 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $150 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, and specialist visits with a $25 copay and no coinsurance. Other benefits include physical and occupational therapy for a $35 copay, mental health sessions for a $40 copay, and podiatry for a $25 copay (all with no coinsurance), although for chiropractic services, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) covers preventive services, including annual physical exams, glaucoma screenings, and diabetes training, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering memory fitness, alternative therapies, and remote access technologies with no copay and no coinsurance, while services like health education, nutritional training, and in-home support are not covered. Kidney disease education is also covered with no copay and a 20% coinsurance.
Hearing Services See details
Hearing services are covered by Wellcare Simple (HMO-POS), featuring Medicare-covered exams for a $25 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 maximum per ear annually, excluding inner ear, outer ear, over the ear, and OTC hearing aids.
Vision Services See details
Vision services are partially covered by Wellcare Simple (HMO-POS), featuring no coinsurance and a $0 to $25 copay for eye exams, with no copay for one annual routine exam. Covered eyewear has no copay and no coinsurance up to a $300 yearly limit, though other eye exam services are not covered.
Dental Services See details
Wellcare Simple (HMO-POS) covers Medicare dental services with a $25 copay and no coinsurance, while preventive and most comprehensive dental services feature no copay and no coinsurance up to a $3,000 annual limit. This benefit is partially covered, as maxillofacial prosthetics, implant services, and orthodontics are not covered.
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 apply. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Simple (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services with prior authorization, featuring no coinsurance for diagnostic tests, no copay for lab services, and a $0 to $50 copay for diagnostic procedures. Diagnostic radiological services have no copay, while outpatient X-rays require a $50 copay and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Wellcare Simple (HMO-POS) covers home health services with a $45.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under Wellcare Simple (HMO-POS), and although some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 41 to 100, a $218 copay for days 21 to 40, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) offers partial coverage for other services, providing over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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