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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 2025, 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 3.5 out of 5 stars in 2025.
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 $51.80. 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 $8850.00 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) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy. For preferred generic drugs, the copay is $19-20, while standard generic drugs have 24-25% coinsurance. Preferred brand drugs have a $100 copay, and non-preferred drugs have 25% coinsurance. Specialty tier drugs have a $0-3 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay, which varies based on the type of care. Outpatient services have copays and coinsurance, while emergency services, primary care, and many preventive services have no copay. The plan also includes coverage for hearing, vision, and dental services, with some services having no copay or a copay. Additional benefits include coverage for home health services, skilled nursing facilities, and medical equipment, with differing cost-sharing structures. The plan has a $90 over-the-counter item benefit every three months and a meal benefit with a doctor's referral.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For Inpatient Hospital-Acute, you will pay a $450 copay for days 1-5, and no copay for days 6-90, with 10 additional days covered with no copay; non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $375 copay for days 1-5, and no copay for days 6-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a 20% coinsurance and a copay between $0 and $350, observation services with a 20% coinsurance and a $110 copay, and ambulatory surgical center services with a $200 copay. The plan also covers outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist (HMO-POS) plan, with a copay of $80.00. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Assist (HMO-POS) plan. Ground and air ambulance services have a $300 copay and no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage all have a copay of $110, and Worldwide Urgent Coverage has a copay of $25; all four of these services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist (HMO-POS) plan covers primary care physician services with no copay and chiropractic services with a $15 copay. Occupational therapy services, individual and group sessions for mental health specialty services, and individual and group sessions for psychiatric services have a $25 copay. Physical therapy and speech-language pathology services have a $25 copay. The plan also covers physician specialist services with a $25 copay, additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with a $25 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include no copay for an annual physical exam, and no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Wellcare Assist (HMO-POS) offers hearing services, including hearing exams with a $25 copay and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $350 per year per ear, and prescription hearing aids (all types) have no copay, while inner ear, outer ear, and over-the-ear prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Assist (HMO-POS) plan offers vision services including eye exams with a copay between $0 and $25, and eyewear with no copay, up to a combined maximum of $200 per year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all have no copay.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $25 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay, and orthodontic services with a $2000 maximum benefit. Prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Assist (HMO-POS) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Assist (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and Medicare-covered medical supplies have a 20% coinsurance with no copay. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $20, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $350, Therapeutic Radiological Services with up to 20% coinsurance, and Outpatient X-Ray Services with a $25 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Assist (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Assist (HMO-POS) plan. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60.
Other Services See details
Other Services include acupuncture with no copay, but requires prior authorization and is limited to 12 treatments per year; over-the-counter items with no copay and a maximum benefit of $90 every three months; and a meal benefit with no copay that requires a doctor's referral. Services such as Dual Eligible SNPs, Early and Periodic Screening, Private Duty Nursing, and others are not covered.
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