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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 Statewide - Indiana. This plan received an overall rating of 3 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 $31.10. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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.
This plan has a $560.00 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-POS) plan features an annual drug deductible of $560, though Tier 6 Select Care Drugs are available with no copay across all pharmacies and mail order options. For Tier 1 Preferred Generic and Tier 2 Generic medications, copays range from $18 to $20 for a one-month supply, but you can benefit from no copay when ordering a three-month supply through preferred mail order. Brand-name and non-preferred medications require coinsurance rather than flat copays, with Tier 3 Preferred Brands requiring 20% coinsurance and Tier 4 Non-Preferred Drugs requiring 32% coinsurance. Tier 5 Specialty Drugs are covered with a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, including no copay for primary care visits and a $25 copay for specialists. Inpatient hospital stays require a $350 daily copay for the first six days and no copay for days seven through 90, while outpatient services range from no copay up to a $280 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also features valuable supplemental benefits, including routine dental, vision, and hearing care with no copay. Members benefit from no copay for home health services, over-the-counter items, and up to 24 one-way trips to plan-approved locations. While most services feature no coinsurance, select benefits such as dialysis and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Assist (HMO-POS) with no coinsurance, requiring prior authorization. Both acute and psychiatric stays require a $350 copay for days 1 through 6 and no copay for days 7 through 90, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Assist (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from no copay to $280, and ambulatory surgical center services with a $225 copay and no coinsurance. Outpatient substance abuse sessions have a $30 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization services are 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 $285 copay and no coinsurance per trip. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
Wellcare Assist (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $40 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO-POS) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered. Additional services like physical and occupational therapy are available with a $35 copay and no coinsurance.
Preventive Services See details
Wellcare Assist (HMO-POS) offers preventive services with no copay and no coinsurance for annual physical exams, select fitness benefits, alternative therapies, and glaucoma screenings, while kidney disease education has no copay and 20% coinsurance. The benefit is partially covered, as sub-services such as health education, weight management programs, medical nutrition therapy, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Assist (HMO-POS) with prior authorization required and no deductible. Medicare-covered exams require a $25 copay and no coinsurance, while annual routine exams, fitting evaluations, and prescription hearing aids (up to $1,000 per ear) have no copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services are covered by Wellcare Assist (HMO-POS) with no deductible, offering one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear, including contact lenses and eyeglasses, is covered with no copay and no coinsurance up to a $400 combined annual maximum.
Dental Services See details
Wellcare Assist (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $25 copay and no coinsurance, and other covered preventive and comprehensive services with no copay and no coinsurance. Maxillofacial prosthetics and orthodontics are not covered, and prior authorization is required for most services.
Home Infusion bundled Services See details
Wellcare Assist (HMO-POS) covers home infusion bundled services with no copay, although prior authorization is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Assist (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Assist (HMO-POS) with prior authorization required, featuring no coinsurance for diagnostic services, which include lab services with no copay and diagnostic tests with a $0 to $75 copay. Radiological services require a $25 copay and coinsurance for outpatient X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance along with a copay for therapeutic radiology.
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 covered by Wellcare Assist (HMO-POS) with no coinsurance and no copayments, though only some services are covered in practice as standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Assist (HMO-POS) with no coinsurance, requiring no copay for days 1 to 20 and 51 to 100, and a $218 daily copay for days 21 to 50. Prior authorization is required, and additional days beyond those covered by Medicare are not covered.
Other Services See details
Wellcare Assist (HMO-POS) offers partial coverage for other services, including over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. A referral is required for the meal benefit, and acupuncture is not covered under this plan.
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