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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 2025, 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 Select counties in SC. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $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 $5200.00 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) plan has a $420 deductible for prescription drugs. In the initial coverage phase, you will pay varying costs depending on the drug tier and whether you use a preferred or standard pharmacy. For example, preferred generic drugs and specialty tier drugs have no copay. You will pay 25% to 34% coinsurance for standard generic and brand name drugs.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a wide range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $350 depending on the service. It also offers coverage for primary care, preventive, hearing, vision, and dental services, often with no copay or low copays. Additional benefits include ambulance services, emergency services, and home health services, with specific copays or coinsurance amounts. Diagnostic and radiological services, home infusion, and medical equipment are also covered, with some services requiring prior authorization or coinsurance. The plan also covers skilled nursing facility services and offers additional services like meal benefits, while some services, such as some rehabilitation services, have limited coverage.
Inpatient Hospital See details
Inpatient Hospital benefits for the Wellcare Simple (HMO-POS) plan include coverage for Inpatient Hospital-Acute with a $325 copay for days 1-6, and no copay for days 7-90, as well as Inpatient Hospital Psychiatric with a $2,106 copay. Additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a copay between $125 and $350, Ambulatory Surgical Center (ASC) Services with a $250 copay, Individual and Group Sessions for Outpatient Substance Abuse with a $25 copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple (HMO-POS) plan, but requires prior authorization. You will have a copay of $105.00 for this benefit.
Ambulance and Transportation Services See details
The Wellcare Simple (HMO-POS) plan covers ambulance services with a $305 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Coverage, are covered by the Wellcare Simple (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $55 copay; all services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services and physical therapy/speech-language pathology services have a $35 copay. Physician specialist services have a $35 copay, and mental health and psychiatric services have a $25 copay for both individual and group sessions. The plan also offers telehealth services with a copay ranging from $0 to $55, and opioid treatment program services with a $35 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Wellcare Simple (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additionally, the plan covers Medicare-covered zero-dollar preventive services, other preventive services, and kidney disease education services. Other preventive services may have a copay, and kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $750 per year with no copay for all types, while OTC hearing aids are not covered.
Vision Services See details
The Wellcare Simple (HMO-POS) plan covers vision services including eye exams and eyewear. Eye exams have a copay of $0-$35, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, but there is a combined maximum plan benefit of $200 per year.
Dental Services See details
The Wellcare Simple (HMO-POS) plan covers dental services, including oral exams, dental x-rays, and other diagnostic services with no copay. It also covers prophylaxis (cleaning), fluoride treatment, other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, but does not cover maxillofacial prosthetics, implant services, or orthodontics. Orthodontic services have a maximum benefit of $1,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and 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 by the Wellcare Simple (HMO-POS) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
The Wellcare Simple (HMO-POS) plan covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetic Devices, and Medical Supplies also have a 20% coinsurance. Diabetic supplies have no copay, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all diagnostic services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $100 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare 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 by the Wellcare Simple (HMO-POS) plan, but the specific services within this category, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple (HMO-POS) plan, but require prior authorization. For days 1-20 and 51-100, there is no copay, while days 21-50 have a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Wellcare Simple (HMO-POS) plan covers meal benefits with no copay and requires a doctor's referral, but acupuncture, over-the-counter items, 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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