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Wellcare Patriot Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Patriot 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 Patriot Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Patriot Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in NY. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Patriot Simple (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Patriot 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 Patriot 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6700.00 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
Prescription drugs are not covered by Wellcare Patriot Simple (HMO-POS).
Additional Benefits
The Wellcare Patriot Simple (HMO-POS) plan offers comprehensive coverage with predictable cost-sharing, featuring no copays for primary care visits, preventive care, and home health services. For specialized medical care, members will pay low copays, such as $20 for specialist visits and a daily copay of $300 for the first five days of inpatient hospital stays. Emergency room visits require a $130 copay, while outpatient surgical services feature a low $50 copay, both with no coinsurance. Members also benefit from no copays on routine dental, vision, and hearing exams, alongside allowances for eyewear and hearing aids. While diagnostic lab tests and x-rays have no copay, durable medical equipment and dialysis services require a 20% coinsurance. Additionally, skilled nursing facility stays feature no copay for the first 20 days, and supplemental benefits like acupuncture and over-the-counter items are covered with no copay.
Inpatient Hospital See details
Wellcare Patriot Simple (HMO-POS) partially covers inpatient hospital services with no coinsurance, featuring a $300 copay per day for days 1 through 5 and no copay for days 6 through 90 for acute care, and a $350 copay per stay for psychiatric care. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Patriot Simple (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $130 to $450 copay per stay for observation services. Ambulatory surgical center services require a $50 copay with no coinsurance, while outpatient substance abuse and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by the Wellcare Patriot Simple (HMO-POS) plan with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellcare Patriot Simple (HMO-POS) covers ground and air ambulance services with a $250 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Patriot Simple (HMO-POS) emergency services are partially covered, featuring a $130 copay for emergency room visits and a $25 copay for urgent care, both with no coinsurance and waived if admitted within 24 hours. Worldwide emergency and urgent services are covered up to a $50,000 maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under the Wellcare Patriot Simple (HMO-POS) plan offer no copay and no coinsurance for primary care, mental health, and psychiatric services, while specialist, physical therapy, occupational therapy, and opioid treatments require a $20 copay and no coinsurance. Chiropractic services are partially covered with no copay and no coinsurance, excluding other chiropractic services, whereas podiatry is not covered. Telehealth and other health care professional services are also covered with no coinsurance and copays ranging from $0 to $25.
Preventive Services See details
Wellcare Patriot Simple (HMO-POS) partially covers preventive services, offering annual physical exams, fitness benefits, alternative therapies, and select screenings with no copay and no coinsurance. While kidney disease education is covered with no copay and a 20% coinsurance, several supplemental benefits like health education, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
Wellcare Patriot Simple (HMO-POS) covers routine hearing exams and fitting evaluations with no copay or coinsurance, though Medicare-covered exams require a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear yearly, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services under Wellcare Patriot Simple (HMO-POS) are partially covered, featuring no coinsurance and no deductibles, with copays ranging from $0 to $20 for eye exams, though other eye exam services are not covered. Routine eye exams (one per year) and eyewear—including lenses, frames, and contacts—have no copay, with a combined annual eyewear maximum benefit of $200.
Dental Services See details
Wellcare Patriot Simple (HMO-POS) offers partially covered dental services, featuring a $20 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for other covered preventive and comprehensive services. While orthodontic services have a $3,000 annual maximum, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Patriot Simple (HMO-POS) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Wellcare Patriot Simple (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Patriot Simple (HMO-POS) covers durable medical equipment, prosthetic devices, and medical supplies with no copay and a 20% coinsurance, with prior authorization required. Diabetic supplies are covered with no copay from specified manufacturers, while diabetic therapeutic shoes and inserts carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Patriot Simple (HMO-POS) covers diagnostic and radiological services, requiring prior authorization for these services. There is no copay and no coinsurance for diagnostic procedures, lab services, diagnostic radiology, and outpatient X-rays, while therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Wellcare Patriot Simple (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Patriot Simple (HMO-POS) features no coinsurance for cardiac rehabilitation, meaning some services are covered, though standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Patriot Simple (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay no copay for days 1 to 20 and days 61 to 100, and a $218 daily copay for days 21 to 60, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Wellcare Patriot Simple (HMO-POS) provides coverage for other services such as acupuncture, over-the-counter (OTC) items, and meals with no copay and no coinsurance. Acupuncture is limited to 24 treatments per year and requires prior authorization, while the meal benefit requires a referral.
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