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Wellcare TexanPlus Classic Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare TexanPlus Classic 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 TexanPlus Classic Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare TexanPlus Classic Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in TX. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Wellcare TexanPlus Classic 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 TexanPlus Classic 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 TexanPlus Classic 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 $3400.00 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:
Sign up for Wellcare TexanPlus Classic Simple (HMO-POS)
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Drug Coverage
The Wellcare TexanPlus Classic Simple (HMO-POS) prescription drug plan features an annual drug deductible of $615. You can save money on generic medications, as Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs have no copay when filled at a preferred pharmacy or through preferred mail order. Furthermore, Tier 6 (Select Care Drugs) are covered with no copay at all network pharmacies and mail order services. For brand-name and specialty prescriptions, costs are based on coinsurance rather than flat copays. Tier 3 (Preferred Brand) and Tier 5 (Specialty Tier) medications require a 25% coinsurance, while Tier 4 (Non-Preferred Drug) prescriptions carry a 37% to 38% coinsurance depending on your pharmacy choice. Standard pharmacies and standard mail order services are also available but come with higher copays for Tier 1 and Tier 2 generic drugs.
Additional Benefits
The Wellcare TexanPlus Classic Simple (HMO-POS) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits and a low $15 copay for specialists. Inpatient hospital stays require a $325 copay per admission, while emergency room visits carry a $150 copay that is waived if you are admitted. Outpatient services and diagnostic tests generally feature no coinsurance and low-to-no copays, though some specialized services like dialysis and durable medical equipment require a 20% coinsurance. This plan also provides robust coverage for routine and preventive care, including annual physicals, routine eye exams, and routine hearing tests with no copays or coinsurance. Members benefit from valuable extras like a $200 annual eyewear allowance, up to $750 per ear for prescription hearing aids, and up to $2,000 annually for preventive and comprehensive dental care with no copay. Additionally, skilled nursing facility stays are covered with no cop pay for the first 20 days, and home health services are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Wellcare TexanPlus Classic Simple (HMO-POS) covers inpatient acute and psychiatric hospital stays with a $325 copay per admission and no coinsurance. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
Wellcare TexanPlus Classic Simple (HMO-POS) covers outpatient hospital services with no coinsurance and a copay ranging from no copay to $200, while outpatient blood services are covered with no copay and no coinsurance. Ambulatory surgical center services require a $100 copay and no coinsurance, and outpatient substance abuse sessions have a $25 copay with no coinsurance.
Partial Hospitalization See details
Wellcare TexanPlus Classic Simple (HMO-POS) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare TexanPlus Classic Simple (HMO-POS) covers ground and air ambulance services with a $225 copay and no coinsurance, though prior authorization is required. While transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Wellcare TexanPlus Classic Simple (HMO-POS) covers emergency services with a $150 copay and urgent care with a $25 copay, with no coinsurance for either service and copays waived if admitted within 24 hours. Worldwide emergency and urgent services 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 TexanPlus Classic Simple (HMO-POS) covers primary care doctor visits with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Additional services like physical and occupational therapy have a $10 copay and no coinsurance, though podiatry is not covered and chiropractic care is only partially covered with routine services excluded.
Preventive Services See details
Wellcare TexanPlus Classic Simple (HMO-POS) covers annual physicals and select screenings with no copay and no coinsurance, while kidney disease education is covered with no copay and a 20% coinsurance. Additional preventive benefits are partially covered, offering memory fitness, alternative therapies, and remote access with no copay and no coinsurance, but excluding services like health education, weight management, and in-home safety assessments.
Hearing Services See details
Wellcare TexanPlus Classic Simple (HMO-POS) covers Medicare-covered hearing exams with a $15 copay and no coinsurance, while routine hearing exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to $750 per ear annually, although OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare TexanPlus Classic Simple (HMO-POS) covers vision services with no coinsurance, including one routine eye exam annually with no copay and a $200 yearly eyewear allowance with no copay. While other eye exams have a copay ranging from no copay to $15, other eye exam services are not covered.
Dental Services See details
Wellcare TexanPlus Classic Simple (HMO-POS) offers partially covered dental services, including preventive and comprehensive care with no copay and no coinsurance up to a $2,000 annual maximum. Medicare-covered dental services require a $15 copay and no coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare TexanPlus Classic Simple (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this plan, Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellcare TexanPlus Classic Simple (HMO-POS) plan with no copay and a 20% coinsurance, though a referral is required.
Medical Equipment See details
Medical equipment is covered by Wellcare TexanPlus Classic Simple (HMO-POS) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare TexanPlus Classic Simple (HMO-POS) with prior authorization and referrals required. Diagnostic procedures and tests have no coinsurance and a copay of $0 to $25, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered under the Wellcare TexanPlus Classic Simple (HMO-POS) plan with no copay and no coinsurance. To access this benefit, both a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Wellcare TexanPlus Classic Simple (HMO-POS) offers Cardiac Rehabilitation Services with no coinsurance and a required referral, meaning some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice. These non-covered services require copayments of $50, $65, $40, and $30 respectively.
Skilled Nursing Facility (SNF) See details
Wellcare TexanPlus Classic Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 41 to 100, and a $218 daily copay for days 21 to 40. Prior authorization and referrals are required, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Wellcare TexanPlus Classic Simple (HMO-POS) provides partial coverage for other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan, and a referral is required to access the meal benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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