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Wellcare TexanPlus Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare TexanPlus 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 Simple (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare TexanPlus 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 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 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 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:
Sign up for Wellcare TexanPlus Simple (HMO-POS)
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Drug Coverage
The Wellcare TexanPlus Simple (HMO-POS) plan has a $420 deductible for prescription drugs. After the deductible, you'll pay either a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will have no copay at preferred and mail order pharmacies, with a $10 copay at standard pharmacies. For specialty drugs, you will have no copay at any pharmacy. The plan also has coinsurance for other drug tiers, ranging from 25% to 36%.
Additional Benefits
The Wellcare TexanPlus Simple (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays depending on the length of stay, and outpatient services, including emergency and specialist care, have copays ranging from $0 to $300. Preventative services, such as an annual physical, and many vision and dental services are covered with no copay. The plan also covers a variety of other services, including home health, skilled nursing, and hearing services, some with copays and others with no copay. Additional benefits include coverage for over-the-counter items, a meal benefit, and coverage for home infusion services. Some services, like dialysis and medical equipment, have coinsurance costs.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-6, and no copay for days 7-90, with no coinsurance; additional days 91-150 have no copay. For Inpatient Hospital Psychiatric, you pay a $250 copay for days 1-5 and no copay for days 6-90, with no coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the Wellcare TexanPlus Simple (HMO-POS) plan. Outpatient Hospital Services have a copay between $0 and $280, Observation Services have a copay between $140 and $280, and Ambulatory Surgical Center (ASC) Services have a $200 copay. Outpatient Substance Abuse Services and Outpatient Blood Services are also covered, with Individual and Group Sessions for Outpatient Substance Abuse each having a $25 copay, and Outpatient Blood Services having no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $130 copay and requires prior authorization and a doctor's referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $300 copay, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $140, $35, and $140 respectively, with no coinsurance. Worldwide Urgent Coverage has a copay of $140, with no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Wellcare TexanPlus Simple (HMO-POS) covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services with a $25 copay, mental health specialty services with a $25 copay, and physical therapy and speech-language pathology services with a $35 copay. Additional telehealth benefits have a copay ranging from $0 to $35, and opioid treatment program services have a $25 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with varying copays depending on the service. Kidney Disease Education Services are covered with a 20% coinsurance. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
The Wellcare TexanPlus Simple (HMO-POS) plan covers hearing exams with a $25 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Wellcare TexanPlus Simple (HMO-POS) covers vision services, including eye exams with a copay of $0-$25. Eyewear is covered with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $100 per year.
Dental Services See details
The Wellcare TexanPlus Simple (HMO-POS) plan covers dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay. Orthodontic services are covered up to a maximum of $1,000 per year. However, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare TexanPlus Simple (HMO-POS) plan. 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 with a doctor referral, and the coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Equipment has a 20% coinsurance for Medicare-covered supplies and a 20% coinsurance for therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with a copay of up to $280, therapeutic radiological services with up to 20% coinsurance, and outpatient X-ray services with a $25 copay. All services require prior authorization and a doctor's referral.
Home Health Services See details
Home Health Services are covered by the Wellcare TexanPlus 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 covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. A doctor referral is required, and there is a copay for covered services, but the amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare TexanPlus Simple (HMO-POS) plan, with a $0 copay for days 1-20 and days 51-100, and a $214 copay for days 21-50. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare TexanPlus Simple (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, a maximum benefit of $81 every three months, and covers Nicotine Replacement Therapy (NRT) and Naloxone. The plan also covers a Meal Benefit with no copay and a doctor's referral is required. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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