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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 Select counties in NC. This plan received an overall rating of 3.5 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) prescription drug plan features an annual deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filled through preferred pharmacies or preferred mail order. If you choose standard pharmacies, copays for a one-month supply of these generic medications range from $5 to $10. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs both require a 25% coinsurance payment. Tier 4 non-preferred drugs carry a 34% coinsurance at preferred pharmacies and 35% coinsurance at standard pharmacies.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage with no copays for primary care visits, home health services, and routine preventive care. For specialist visits, physical therapy, and urgent care, members pay low copays ranging from $20 to $30 with no coinsurance. Inpatient hospital stays require a $350 copay for the first few days, after which there is no copay, while emergency room visits carry a flat $150 copay. This plan also features robust supplemental benefits, including routine dental, vision, and hearing exams with no copays or coinsurance. Members receive generous annual allowances, including up to $4,000 for dental care, $500 for eyewear, and $750 per ear for prescription hearing aids with no copays. Additionally, over-the-counter items are covered with no copay, while durable medical equipment and dialysis services require a standard 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) partially covers inpatient hospital services with no coinsurance, excluding upgrades and non-Medicare-covered stays. Covered acute stays require a $350 copay for days 1 through 6 and no copay for days 7 through 95, while psychiatric stays require a $350 copay for days 1 through 7 and no copay for days 8 through 90.
Outpatient Services See details
Outpatient services are covered by Wellcare Simple (HMO-POS) with no coinsurance, featuring copays of $0 to $450 for hospital outpatient services, $150 to $450 per stay for observation services, and $225 for ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. While transportation services are technically covered, trips to plan-approved or any health-related locations are not covered in practice.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum benefit with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialists, physical therapy, and occupational therapy require a $20 copay and no coinsurance. Mental health and psychiatric sessions have a $25 copay with no coinsurance, telehealth services range from no copay to a $30 copay with no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) covers preventive services with no copay and no coinsurance for annual physical exams, fitness benefits, and select screenings, while kidney disease education has no copay but a 20% coinsurance. This benefit is partially covered, as several supplemental services—including health education, in-home safety assessments, personal emergency response systems, and nutritional benefits—are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Simple (HMO-POS), offering routine hearing exams and fitting evaluations with no copay and no coinsurance, and Medicare-covered exams for a $20 copay and no coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) covers vision services with no coinsurance or deductibles, offering one routine eye exam per year with no copay and a $500 annual limit on eyewear with no copay. Prior authorization is required for services, and other eye exam services are not covered.
Dental Services See details
Wellcare Simple (HMO-POS) offers partially covered dental services, with a $20 copay and no coinsurance for Medicare-covered services, and no copay and no coinsurance for preventive and most comprehensive services up to a $4,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs feature a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Wellcare Simple (HMO-POS) with prior authorization, featuring no coinsurance for diagnostic tests and no copay for lab services. Outpatient diagnostic procedures have copays ranging from $0 to $100, while radiological services involve a $50 copay for X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Wellcare Simple (HMO-POS) with no copay and no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellcare Simple (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 41 through 100, while days 21 through 40 require a $218 daily copay, with no coverage provided for additional days beyond the Medicare limit.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance via reimbursement. Acupuncture and meal benefits are not covered under this plan.
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