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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 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 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 $51.40. 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 $590.00 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 $9250.00 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 $590. For Tier 6 select care drugs, you will pay no copay across all pharmacy and mail-order options. Generic medications in Tier 1 and Tier 2 offer low copays, starting at $18 and $19 respectively for a one-month supply at preferred pharmacies, with no copay required for a three-month supply filled through preferred mail order. Higher-tier medications under this plan utilize a mix of copays and coinsurance. Tier 3 preferred brand drugs and Tier 5 specialty drugs both require a 25% coinsurance. For Tier 4 non-preferred drugs, you can expect a $100 copay for a one-month supply at both standard and preferred pharmacies.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers comprehensive healthcare coverage featuring no copay and no coinsurance for primary care visits, telehealth services, and routine preventive care. For specialist visits, mental health services, and physical therapy, members pay a $25 copay with no coinsurance. Inpatient hospital stays require a copay for the first five days, followed by no copay for the remainder of the stay, while emergency care is available for a $115 copay. This plan also includes valuable supplemental benefits, such as routine dental and vision services with no copay, including up to $1,500 annually for dental and $200 for eyewear. Prescription hearing aids are covered up to $500 per ear annually with no copay, and members can access over-the-counter items and acupuncture treatments with no copay or coinsurance. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Wellcare Assist (HMO-POS) covers inpatient hospital services with no coinsurance, although prior authorization is required. For acute stays, there is a $475 copay for days 1-5 and no copay for days 6-100, while psychiatric stays carry a $400 copay for days 1-5 and no copay for days 6-90. Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Assist (HMO-POS), featuring ambulatory surgical center visits for a $300 copay with no coinsurance and outpatient blood services with no copay or coinsurance. Outpatient hospital services require a copay ranging from no copay to $500 along with 30% coinsurance, while observation services cost a $115 copay per stay and 30% coinsurance, and substance abuse sessions have a $25 copay and no coinsurance.
Partial Hospitalization See details
Wellcare Assist (HMO-POS) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellcare Assist (HMO-POS) covers ground and air ambulance services with a $325 copay and no coinsurance, requiring prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Wellcare Assist (HMO-POS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO-POS) covers primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist visits, therapy, and mental health services require a $25 copay and no coinsurance. Routine chiropractic care is available for a $15 copay with no coinsurance, but other chiropractic services and podiatry services are not covered.
Preventive Services See details
Wellcare Assist (HMO-POS) covers annual physical exams, fitness benefits, alternative therapies, and remote access technologies with no copay and no coinsurance, though some additional services like health education and in-home safety assessments are not covered. Kidney disease education is covered with no copay and a 20% coinsurance, while other preventive services like glaucoma and diabetes screenings have no copay and no coinsurance.
Hearing Services See details
Wellcare Assist (HMO-POS) covers hearing exams with no deductible, no coinsurance, and a $25 copay for Medicare-covered exams, while annual routine exams and fitting evaluations have no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Assist (HMO-POS) with no coinsurance or deductibles, featuring no copay for yearly routine eye exams and eyewear up to a $200 annual limit, though other eye exam services are not covered. Prior authorization is required for these benefits, and certain eye exams may require a copay of up to $25.
Dental Services See details
Wellcare Assist (HMO-POS) partially covers dental services with a $25 copay and no coinsurance for Medicare-covered care, and no copay and no coinsurance for preventive and other covered dental services up to a $1,500 annual maximum. Non-covered services include removable prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Wellcare Assist (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from no coinsurance up to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
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
Wellcare Assist (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 Assist (HMO-POS), though prior authorization is required. Diagnostic lab services have no copay or coinsurance, diagnostic procedures range from a $0 to $50 copay, outpatient X-rays require a $50 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
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
Cardiac Rehabilitation Services are covered under Wellcare Assist (HMO-POS) with no coinsurance, but some services are not covered, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, which require copays ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellcare Assist (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and 71 to 100, a $218 daily copay for days 21 to 70, and additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Wellcare Assist (HMO-POS) provides partial coverage for other services, offering acupuncture for up to 12 treatments per year and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits and other miscellaneous services are not covered under this plan.
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