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Wellcare Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Assist (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 Assist (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 Assist (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 Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.70. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $475.00 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 $5900.00 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 Assist (HMO-POS) prescription drug plan features an annual drug deductible of $475. You will pay no copay for Tier 6 select care drugs at both preferred and standard pharmacies, as well as through mail order. Tier 1 preferred generic and Tier 2 generic drugs have low copays starting at $18 and $19 respectively for a one-month supply, and you can get a three-month supply of these drugs with no copay when using preferred mail order. For higher-tier medications, Tier 3 preferred brand drugs require a 21% coinsurance across all pharmacy types. Tier 4 non-preferred drugs have a $100 copay for a one-month supply, while Tier 5 specialty tier drugs carry a 25% coinsurance for a one-month supply at preferred and standard pharmacies. Standard pharmacies and mail-order options are also available with varying copays and coinsurance rates depending on the drug tier and supply duration.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care physician visits, preventive services, and home health care. Specialist visits require a $20 copay, while inpatient hospital stays incur a $350 daily copay for the first six days, and outpatient hospital services range from no copay up to a $300 copay. Emergency room visits carry a $130 copay and urgent care costs $30, with copays waived if you are admitted within 24 hours. This plan also features robust supplemental benefits, including preventive and comprehensive dental care with no copay up to a $4,000 annual limit. Members benefit from routine eye exams and eyewear with no copay up to a $300 annual limit, prescription hearing aids up to $750 per ear, and up to 36 one-way transportation trips per year to approved locations with no copay. Additionally, over-the-counter items and diabetic supplies are covered with no copay, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Wellcare Assist (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 6 of an acute stay (no copay for days 7 through 95) and a $250 daily copay for days 1 through 7 of a psychiatric stay (no copay for days 8 through 90). This benefit is partially covered, as prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Assist (HMO-POS) covers outpatient services with no coinsurance, featuring outpatient hospital copays ranging from $0 to $300 and ambulatory surgical center copays of $175. Outpatient substance abuse services require a $25 copay per session, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under Wellcare Assist (HMO-POS) with a $140.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Assist (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance. Transportation benefits are partially covered, offering up to 36 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Assist (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance, with copays waived if admitted within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum benefit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO-POS) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with a $25 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Assist (HMO-POS) covers preventive services, offering no copay and no coinsurance for annual physical exams, screenings, fitness benefits, remote access technologies, and alternative therapies, while kidney disease education has no copay and a 20% coinsurance. Additional preventive benefits are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission 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 covered by Wellcare Assist (HMO-POS) feature no coinsurance, with a $20 copay for Medicare-covered exams and no copay for annual routine exams, fitting evaluations, and prescription hearing aids up to $750 per ear. OTC hearing aids and specific prescription models, including inner ear, outer ear, and over-the-ear devices, are not covered.
Vision Services See details
Wellcare Assist (HMO-POS) provides partially covered vision services, offering eye exams with a $0 to $20 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contact lenses, eyeglasses, lenses, frames, and upgrades, has no copay, no coinsurance, and a combined maximum benefit of $300 per year.
Dental Services See details
Wellcare Assist (HMO-POS) partially covers dental services, offering Medicare-covered dental with a $20 copay and no coinsurance, and preventive and most comprehensive services with no copay and no coinsurance up to a $4,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Wellcare Assist (HMO-POS) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Assist (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Assist (HMO-POS) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are available with no copay, while diabetic therapeutic shoes and inserts incur a 20% coinsurance, with prior authorization required.
Diagnostic and Radiological Services See details
Wellcare Assist (HMO-POS) covers diagnostic and radiological services with prior authorization required. Diagnostic tests have no coinsurance and a $0 to $50 copay, lab services have no copay or coinsurance, and diagnostic radiological services have a copay starting at $0. Therapeutic radiological services require a 20% coinsurance, while outpatient X-rays have a $35 copay.
Home Health Services See details
Home Health Services are covered under the Wellcare Assist (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Assist (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, but some services are covered while others are not. Specifically, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered and require copays of $40.00, $50.00, $35.00, and $25.00 respectively.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellcare Assist (HMO-POS) with no coinsurance, featuring no copay for days 1 to 20 and 51 to 100, and a $218 daily copay for days 21 to 50. Prior authorization is required, and while a prior three-day hospital stay is not required, additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Wellcare Assist (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 plan, and the meal benefit requires a referral.
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