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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 2025, 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 3.5 out of 5 stars in 2025.
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 a wide range of benefits with varying costs. Many services have no copay, including primary care visits, routine hearing and eye exams, dental services, and home health services. You will pay a copay for services like inpatient hospital stays, outpatient services, specialist visits, and some therapies. The plan also includes coverage for emergency services, hearing aids, and vision and dental care. Depending on the service, you may have a copay, coinsurance, or both. Other benefits include coverage for home infusion, dialysis, medical equipment, diagnostic and radiological services, skilled nursing facility, and other services like acupuncture and OTC items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you will pay a $300 copay for days 1-5, and no copay for days 6-90. For inpatient psychiatric care, you will pay a $350 copay per admission or stay.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $500, and Observation Services have a copay between $125 and $500. ASC services have a $50 copay. Outpatient Substance Abuse Services, including individual and group sessions, have no copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Patriot Simple (HMO-POS) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Patriot Simple (HMO-POS) plan. Ground and Air Ambulance Services have a $250 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Patriot Simple (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay and no coinsurance, and Urgently Needed Services have a $25 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services and Routine Chiropractic Care are covered with no copay, and require prior authorization. Occupational Therapy Services have a $20 copay. Physician Specialist Services have a $20 copay. Mental Health and Psychiatric Services have no copay for individual and group sessions. Other Health Care Professional services have a copay between $0 and $20. Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a copay between $0 and $25. Opioid Treatment Program Services have a $20 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services with a copay, including Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a Welcome Visit. Kidney disease education services have a 20% coinsurance. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Alternative therapies, fitness benefits, and remote access technologies (including web/phone-based technologies and nursing hotline) are covered with no copay.
Hearing Services See details
Wellcare Patriot Simple (HMO-POS) covers hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a plan-specified amount of $750 per year. OTC hearing aids, and some prescription hearing aids are not covered.
Vision Services See details
The Wellcare Patriot Simple (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $20, while routine eye exams have no copay, and eyewear has a $200 combined maximum benefit per year with no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Wellcare Patriot Simple (HMO-POS) plan covers dental services, including oral exams, dental x-rays, and other diagnostic, preventive, restorative, and adjunctive general services with no copay. Orthodontic services have a maximum benefit of $3,000 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. This includes a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Patriot Simple (HMO-POS) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance; Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellcare Patriot Simple (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, and Lab Services have no copay; Diagnostic Radiological Services have a copay up to $75.00, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Wellcare Patriot 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 Patriot Simple (HMO-POS) plan, but the specific services are not covered. Further details on the copay are available in the plan documents.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Patriot Simple (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60. Additional days beyond Medicare and non-Medicare stays for SNF are not covered.
Other Services See details
The Wellcare Patriot Simple (HMO-POS) plan covers acupuncture with no copay, and over-the-counter (OTC) items with no copay, up to $100 every three months, and a meal benefit with no copay that requires a doctor referral. Several other services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services.
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