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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 - Indiana. 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 $37.90. 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 $500.00 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 $5700.00 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 $500 deductible for prescription drugs. After meeting your deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. The copays range from $19 to $100, and coinsurance is either 22% or 25%. For specialty tier drugs, you'll have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Assist (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. You can expect no copay for primary care physician visits, preventive services like annual physical exams, and various dental services. Other services like hearing, vision, and home health services are also covered with no copay, or with copays between $0 and $25. The plan also covers emergency services, ambulance and transportation services, and home infusion services. Additionally, this plan provides coverage for diagnostic and radiological services. Some services, such as dental, hearing, and vision, have annual maximums or specific coverage limits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Wellcare Assist (HMO) plan. For days 1-6, there is a $350 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $280, observation services with a copay between $125 and $280, and ambulatory surgical center services with a $225 copay. Outpatient substance abuse services have a copay of $30 for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist (HMO) plan, but requires prior authorization. The copay for this service is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Assist (HMO) plan, with a $285 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a Plan Approved Health-related Location are covered with no copay, but Transportation Services to any Health-related Location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services have a $40 copay, with no coinsurance for any of these services. 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 have a $20 copay, while occupational therapy services have a $35 copay. Physician specialist services have a $25 copay, and mental health specialty services, including individual and group sessions, have a $30 copay. Podiatry services and other health care professional services have a copay of $25, psychiatric services have a $30 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $0 and $40, and opioid treatment program services have a $25 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with varying copays. Kidney Disease Education Services have a 20% coinsurance. Glaucoma screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visits have no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $25 copay, routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids have a maximum benefit of $1,000 per year.
Vision Services See details
Vision services include eye exams and eyewear, with eye exams costing between $0 and $25. Eyewear has a combined maximum of $400 per year, and there is no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services for the Wellcare Assist (HMO) plan include a $25 copay for Medicare Dental Services, and no copay for 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 and fixed), and oral and maxillofacial surgery. Orthodontic services are covered up to a maximum of $3000 per year, while 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 prior authorization is required. 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, with a coinsurance of 20%.
Medical Equipment See details
The Wellcare Assist (HMO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetic Devices and Medical Supplies with a 20% coinsurance, and Diabetic Supplies with no copay, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $75, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $280, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $25 copay. All services require prior authorization.
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, but the plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. The copay for this benefit is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Assist (HMO) plan, but require prior authorization. There is no copay for days 1-20 and days 51-100, but there is a $214 copay for days 21-50. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items and meal benefits, with no copay for OTC items. Acupuncture, 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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