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Wellcare Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 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 Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Statewide in DE. The overall rating for this plan is not yet available for 2026.
It's important to know that Wellcare 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 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 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 $6000.00 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 (HMO-POS) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 (Select Care Drugs) are available with no copay across all standard and preferred pharmacies and mail-order options. For Tier 3 (Preferred Brand) and Tier 5 (Specialty Tier) drugs, you will pay a 25% coinsurance. Tier 4 (Non-Preferred Drugs) require a coinsurance of 33% at preferred pharmacies or 34% at standard pharmacies. Standard pharmacies also require copays for Tier 1 and Tier 2 drugs, ranging from $5 to $30 depending on the supply duration.
Additional Benefits
Wellcare Simple (HMO-POS) provides robust healthcare coverage with no copay for primary care doctor visits, home health services, and annual physical exams. Specialist visits require a $30 copay, while acute inpatient hospital stays feature a $300 daily copay for the first nine days and no copay for days 10 through 90. Emergency care is covered with a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Additional perks include preventive and comprehensive dental care with no copay, as well as routine eye exams and up to $200 for annual eyewear with no copay. Prescription hearing aids are covered up to $500 per ear annually with no copay, and over-the-counter items are also provided at no cost. For medical supplies, durable medical equipment, and dialysis services, members will pay a 20% coinsurance with no copay.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient hospital services with no coinsurance, requiring prior authorization for stays. Acute hospital stays require a $300 daily copay for days 1 through 9 and no copay for days 10 through 90, while psychiatric stays require a $1,875 copay per stay; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Simple (HMO-POS) with no coinsurance for all services, featuring copays ranging from $0 to $375 for outpatient hospital services and a $250 copay for ambulatory surgical center visits. Outpatient substance abuse sessions require a $25 copay, while outpatient blood services are provided with no copay.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) partially covers ambulance and transportation services, with ground and air ambulance services requiring prior authorization and carrying a $305 copay with no coinsurance. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum benefit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) provides primary care physician services with no copay and no coinsurance, while specialist visits and therapy services require a $30 copay and no coinsurance. Mental health and psychiatric sessions have a $25 copay and no coinsurance, telehealth ranges from no copay to a $30 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) covers annual physical exams and most preventive services with no copay and no coinsurance, although kidney disease education requires a 20% coinsurance with no copay. Additional supplemental preventive benefits are partially covered, offering fitness benefits, alternative therapies, and remote access technologies, while services such as health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Wellcare Simple (HMO-POS) hearing services are partially covered, featuring a $30 copay and no coinsurance for Medicare-covered exams, while routine exams and fitting evaluations have no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision Services from Wellcare Simple (HMO-POS) include one routine eye exam per year with no copay and no coinsurance, although other eye exam services are not covered. Eyewear, including contacts, lenses, and frames, is covered with no copay and no coinsurance up to a $200 annual maximum.
Dental Services See details
Wellcare Simple (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $30 copay and no coinsurance, and other preventive and comprehensive dental services with no copay and no coinsurance. However, prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellcare Simple (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are also covered with no copay, though manufacturer limitations apply, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO-POS) subject to prior authorization. Diagnostic services require no coinsurance, featuring no copay for lab tests and a $0 to $75 copay for diagnostic procedures. Radiological services include diagnostic radiology starting at no copay, outpatient X-rays with a $50 copay plus coinsurance, and therapeutic radiology requiring a copay and a minimum 20% coinsurance.
Home Health Services See details
Wellcare Simple (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under Wellcare Simple (HMO-POS), and although some services are covered, standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation (with a $50 copay), pulmonary rehabilitation (with a $35 copay), and supervised exercise therapy for peripheral artery disease (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and 51 to 100, a $218 copay per day for days 21 to 50, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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