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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 2026, 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 4 out of 5 stars in 2026.
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 $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 $9250.00 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 features an annual prescription drug deductible of $615. For budget-friendly medications, members pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when filled through preferred pharmacies or preferred mail-order services. Standard pharmacy copays for these lower-tier prescriptions are also highly competitive, starting at just $5 for a one-month supply of preferred generics. For higher-tier medications, drug coverage costs shift to a coinsurance model. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance at both standard and preferred pharmacies. Tier 4 non-preferred drugs carry a 33% coinsurance at preferred pharmacies and preferred mail-order, increasing slightly to 34% coinsurance at standard pharmacies.
Additional Benefits
The Wellcare Simple Value (HMO-POS) plan offers comprehensive healthcare coverage with no copay and no coinsurance for primary care physician visits and preventive services. Specialist visits require a $25 copay, while inpatient hospital stays have a daily copay of $438 for acute stays and $500 for psychiatric stays for the first four days, followed by no copay. Additionally, emergency room visits carry a $115 copay, and outpatient services generally feature no copay with 20% to 30% coinsurance. For specialized care, the plan covers home health care with no copay and provides preventive dental and routine vision services with no copay, although major dental work and hearing aids are not covered. Skilled nursing facility stays feature no copay for days 1 to 20 and days 71 to 100, but require a $218 daily copay for days 21 to 70. This plan does not cover acupuncture, over-the-counter items, or meal benefits, meaning members will pay for these services out of pocket.
Inpatient Hospital See details
Wellcare Simple Value (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $438 daily copay for days 1 to 4 of acute stays and a $500 daily copay for days 1 to 4 of psychiatric stays, followed by no copay for days 5 to 90. Prior authorization and referrals are required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple Value (HMO-POS) covers outpatient hospital services with no copay and 20% to 30% coinsurance, while outpatient observation services require a $115 copay per stay and 30% coinsurance. Ambulatory surgical center and outpatient substance abuse services feature no copay and 20% coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple Value (HMO-POS) for a $105.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Simple Value (HMO-POS), which features a 20% coinsurance and no copay for ground and air ambulance services requiring prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Wellcare Simple Value (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple Value (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits and occupational therapy require a $25 copay and no coinsurance. Mental health and psychiatric services are covered with no copay and 20% coinsurance, but chiropractic and podiatry services are not covered under this plan. Physical therapy has a $50 copay with no coinsurance, and telehealth benefits are available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Wellcare Simple Value (HMO-POS) covers preventive services, including annual physicals, alternative therapies, memory fitness, remote access, and various screenings with no copay and no coinsurance, while kidney disease education has a 20% coinsurance and no copay. These additional benefits are partially covered, excluding services such as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Wellcare Simple Value (HMO-POS), offering covered hearing exams with a $25 copay, no coinsurance, and no deductible, though prior authorization is required. However, routine hearing exams, fitting evaluations, and all prescription and over-the-counter hearing aids are not covered.
Vision Services See details
Wellcare Simple Value (HMO-POS) partially covers vision services with no coinsurance and no deductible, offering routine eye exams and eyewear with no copay up to a $100 annual limit. Eye exams have a copay ranging from $0 to $25, but other eye exam services are not covered.
Dental Services See details
Wellcare Simple Value (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $25 copay and no coinsurance, and preventive and adjunctive services with no copay and no coinsurance. Restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple Value (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Simple Value (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance. A referral is required to receive these covered services.
Medical Equipment See details
Wellcare Simple Value (HMO-POS) covers medical equipment, offering durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts require 20% coinsurance, with prior authorization required for most items.
Diagnostic and Radiological Services See details
Wellcare Simple Value (HMO-POS) covers diagnostic and radiological services, requiring referrals and prior authorization. Diagnostic tests and diagnostic radiological services have no copay and a 20% coinsurance, lab services have no copay, and outpatient X-rays require a $50 copay and coinsurance.
Home Health Services See details
Wellcare Simple Value (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Simple Value (HMO-POS) with no coinsurance, though a referral is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple Value (HMO-POS) partially covers skilled nursing facility (SNF) services with no coinsurance, though additional days beyond the standard 100-day Medicare limit are not covered. Covered stays require prior authorization and referrals, featuring no copay for days 1 to 20 and days 71 to 100, and a daily copay of $218 for days 21 to 70.
Other Services See details
Wellcare Simple Value (HMO-POS) does not cover Other Services, meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, and meal benefits. Members will be responsible for the full cost of these services out of pocket.
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