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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 SC. This plan received an overall rating of 4 out of 5 stars in 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 $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) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, beneficiaries can benefit from no copay when utilizing preferred pharmacies or preferred mail-order services. Standard pharmacies are also available for these generic tiers with affordable copays ranging from $5 to $30 depending on the supply fill. For brand-name and specialty medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 34% or 35% coinsurance depending on whether you use a preferred or standard pharmacy. This clear cost structure helps you easily estimate your out-of-pocket prescription expenses.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits, annual preventive services, and home health care. For specialized care, members can expect a $40 copay for specialist visits and a $325 daily copay for the first six days of inpatient hospital stays. Emergency care carries a $130 copay, while urgent care services are available with a $50 copay, both with no coinsurance. This plan also provides valuable supplemental benefits, including routine dental, vision, and hearing services with no copays, alongside annual allowances for eyewear and hearing aids. While many diagnostic lab tests and home infusion services feature no copays, other services like dialysis and durable medical equipment require a 20% coinsurance. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days of care.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) partially covers inpatient hospital care with no coinsurance, excluding upgrades, additional days, and non-Medicare-covered stays. Acute stays require a $325 daily copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays require a $1,750 copay per stay.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services with no coinsurance, featuring a range of no copay to a $400 copay for outpatient hospital services and a $130 to $400 copay per stay for observation services. Ambulatory surgical center services require a $350 copay, outpatient substance abuse sessions have a $25 copay, and outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple (HMO-POS) with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Simple (HMO-POS), featuring a $350 copay and no coinsurance for ground and air ambulance services, which require prior authorization. For transportation benefits, some services are covered, but transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both with no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 lifetime maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) offers primary care visits with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, and speech therapies have a $35 copay with no coinsurance, mental health services have a $25 copay with no coinsurance, and podiatry services are not covered. Some chiropractic services are covered, though routine and other chiropractic services are not, and telehealth benefits are available with no coinsurance and copays ranging from $0 to $50.
Preventive Services See details
Wellcare Simple (HMO-POS) covers preventive services, offering annual physical exams, fitness benefits, remote access, and screenings with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, though additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by Wellcare Simple (HMO-POS), with Medicare-covered exams requiring a $40 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Wellcare Simple (HMO-POS), featuring no coinsurance and requiring prior authorization for services. Routine eye exams (one per year) and eyewear—including contacts and glasses up to a $200 annual limit—are available with no copay, though other eye exam services are not covered and some exams may carry a copay up to $40.
Dental Services See details
Wellcare Simple (HMO-POS) partially covers dental services, featuring Medicare-covered dental services for a $40 copay and no coinsurance, and preventive and comprehensive dental care with no copay and no coinsurance up to a $1,500 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple (HMO-POS) with no copay, though prior authorization and step therapy may apply. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Simple (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO-POS) with prior authorization, featuring no coinsurance alongside no copay for lab tests and a $0 to $100 copay for diagnostic procedures. Radiological services include diagnostic radiology with a $0 minimum copay and no coinsurance, outpatient X-rays with a $40 copay and coinsurance, and therapeutic radiology with a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no copay and no coinsurance under the Wellcare Simple (HMO-POS) plan; however, only some services are covered, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 to 20 and days 51 to 100, a $218 daily copay for days 21 to 50, and additional days beyond the standard 100 days are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, providing a chronic illness meal benefit with no copay and no coinsurance, though a referral is required. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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