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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 2025, 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 3.5 out of 5 stars in 2025.
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 $420.00 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:
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Drug Coverage
The Wellcare TexanPlus Classic Simple (HMO-POS) plan has a $420 deductible for prescription drugs. After the deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. For specialty drugs, you will have no copay.
Additional Benefits
The Wellcare TexanPlus Classic Simple (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a $325 copay per admission, outpatient services with varying copays, and emergency services with a $140 copay. The plan also covers primary care, preventive services, hearing, vision, and dental services, many of which have no copay. Additional benefits include ambulance and transportation services, home health services with no copay, and skilled nursing facility services with a copay that varies depending on the length of stay. The plan also offers coverage for medical equipment, diagnostic and radiological services, and other services like home infusion and dialysis, with varying copays and coinsurance amounts.
Inpatient Hospital See details
The Wellcare TexanPlus Classic Simple (HMO-POS) plan covers inpatient hospital stays, with a copay of $325 per admission for Medicare-covered stays, and additional days for inpatient hospital-acute with no copay for days 91-150, up to 60 additional days per benefit period. Non-Medicare-covered stays and upgrades for inpatient hospital acute, as well as additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$225, Observation Services with a copay of $140-$225, Ambulatory Surgical Center (ASC) Services with a copay of $125, Outpatient Substance Abuse Services with a copay of $25 for both Individual and Group Sessions, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral may be required.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $130 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location have no copay for up to 24 one-way trips per year, using rideshare services, bus/subway, or medical transport. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare TexanPlus Classic Simple (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services have a $25 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare TexanPlus Classic Simple (HMO-POS) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, and Occupational Therapy Services with a $35 copay. The plan also covers Physician Specialist Services with a $15 copay, and Mental Health Specialty Services with a $25 copay for both individual and group sessions. Additionally, the plan covers Physical Therapy and Speech-Language Pathology Services with a $35 copay, Additional Telehealth Benefits with a copay between $0 and $35, and Opioid Treatment Program Services with a $15 copay. However, Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Wellcare TexanPlus Classic Simple (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including alternative therapies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with no copay. Kidney Disease Education Services are covered with a 20% coinsurance.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered. Hearing exams have a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, with a maximum benefit of $750 per year, and Prescription Hearing Aids (all types) have no copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$15, and routine eye exams have no copay. Eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, with a combined maximum benefit of $200 per year.
Dental Services See details
The Wellcare TexanPlus Classic Simple (HMO-POS) plan covers dental services, including oral exams, dental x-rays, and other diagnostic dental services with no copay; it also covers prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Orthodontic services are covered up to a maximum of $2000 per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, 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 TexanPlus Classic Simple (HMO-POS) plan, with a doctor referral required. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered by the Wellcare TexanPlus Classic Simple (HMO-POS) plan, with Durable Medical Equipment (DME) requiring prior authorization and a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic equipment is covered with a 20% coinsurance for diabetic therapeutic shoes or inserts. There is no copay for diabetic supplies, and the plan requires prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include diagnostic procedures and tests with a copay between $0 and $25, and lab services with no copay. Diagnostic radiological services have a copay of at most $200, while therapeutic radiological services have at least 20% coinsurance, and outpatient X-ray services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare TexanPlus Classic Simple (HMO-POS) 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 not covered by the Wellcare TexanPlus Classic Simple (HMO-POS) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits. The OTC benefit has no copay, with a maximum benefit of $89 every three months, and the Meal Benefit has no copay and requires a doctor's referral. 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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