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Wellcare Simple Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Value (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 Value (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Simple Value (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 Simple Value (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 Value (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 Value (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 $9350.00 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 Value (HMO-POS) plan has a $420 deductible for prescription drugs. After you meet your deductible, your costs will vary depending on the drug tier and pharmacy you use. For example, you will pay no copay for preferred generic drugs and specialty tier drugs at any pharmacy. You'll pay 25% coinsurance for standard generic drugs, 37% coinsurance for preferred brand drugs, and 28% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for your covered drugs.
Additional Benefits
The Wellcare Simple Value (HMO-POS) plan offers a range of benefits, including coverage for inpatient hospital stays with copays, outpatient services with varying coinsurance and copays, and partial hospitalization. The plan also covers primary care with no copay, specialist visits with a $25 copay, and offers vision and dental services with copays and no copays for certain services. This plan provides coverage for emergency services, and ambulance services with coinsurance. Preventive services, such as annual physical exams, and other services like home health and skilled nursing facilities, are covered with no or low copays, or with coinsurance. However, this plan does not cover some services, including Cardiac Rehabilitation Services, and Other Services.
Inpatient Hospital See details
The Wellcare Simple Value (HMO-POS) plan covers inpatient hospital stays, including acute and psychiatric services, but requires prior authorization and a doctor's referral. For inpatient hospital-acute services, there is a $438 copay for days 1-4 and no copay for days 5-90, and for inpatient hospital-psychiatric services, there is a $509 copay for days 1-4 and no copay for days 5-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 20-30% coinsurance and no copay, Observation Services with a 30% coinsurance and a $110 copay, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance, Outpatient Substance Abuse Services with a 20% coinsurance, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple Value (HMO-POS) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellcare Simple Value (HMO-POS) plan. Ground and Air Ambulance Services have a 20% coinsurance, and Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services under the Wellcare Simple Value (HMO-POS) plan include a $110 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Value (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy with a $25 copay. The plan also covers physician specialist services with a $25 copay, and mental health specialty services with 20% coinsurance for individual and group sessions. Other covered services include other health care professionals with a copay between $0 and $25, psychiatric services with 20% coinsurance for individual and group sessions, and physical therapy and speech-language pathology services with a $50 copay. Additionally, the plan offers additional telehealth benefits with 20% coinsurance and a copay between $0 and $50, and opioid treatment program services with a $25 copay.
Preventive Services See details
The Wellcare Simple Value (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are also covered, including Fitness Benefit, Remote Access Technologies, and Alternative Therapies, all with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services are covered, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services, as offered by Wellcare Simple Value (HMO-POS), include hearing exams with a $25 copay; however, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Simple Value (HMO-POS) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $100 per year.
Dental Services See details
The Wellcare Simple Value (HMO-POS) plan covers Medicare Dental Services with a $25 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Orthodontic services are also covered, but restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay, and other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple Value (HMO-POS) plan, and require a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Wellcare Simple Value (HMO-POS) plan, with Durable Medical Equipment (DME) subject to 20% coinsurance and requiring prior authorization. Prosthetic Devices and Medical Supplies have a coinsurance of 20%, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts are subject to 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a coinsurance of at most 20%, Lab Services with no copay, Diagnostic Radiological Services with a coinsurance of at most 20% and no copay, Therapeutic Radiological Services with a coinsurance of at most 20%, and Outpatient X-Ray Services with a $70 copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple Value (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 Simple Value (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Value (HMO-POS) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20 and days 51-100, but there is a $214 copay for days 21-50.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefits, 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. No authorization or referral is required for these services.
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