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Wellcare Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 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 Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare 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 Simple (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 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 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.
This plan has a $615.00 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 Simple (HMO-POS) prescription drug plan features an annual drug deductible of $615. Members can save on medication costs by utilizing preferred pharmacies or preferred mail-order services, which offer no copay for Tier 1 preferred generic and Tier 2 generic drugs. Additionally, Tier 6 select care drugs are highly accessible with no copay across all standard and preferred network pharmacies. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 33% coinsurance. Standard pharmacies and standard mail-order services are also available for generic tiers, with copays ranging from $5 to $30 depending on the tier and supply length.
Additional Benefits
The Wellcare Simple (HMO-POS) Medicare plan offers affordable coverage for your everyday healthcare needs, featuring no copay for primary care visits, select telehealth services, and routine preventive care. Specialist visits require a $25 copay, while inpatient hospital stays are covered with daily copays for the first four days and no copay for days five through ninety. Emergency room visits carry a $115 copay, and urgent care is available for a $40 copay. This plan also provides excellent supplemental benefits, including no copay for routine dental services, annual eye exams, eyewear up to a $200 annual limit, and routine hearing exams. Home health services and home infusion bundled services are fully covered with no copay, though prior authorization is required. Additionally, members can access diagnostic lab services and annual physicals with no copay.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $600 daily copay for days 1 to 4 of acute stays and a $500 daily copay for days 1 to 4 of psychiatric stays, followed by no copay for days 5 to 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient hospital services with no copay and 30% coinsurance, and outpatient observation services for a $115 copay per stay and 30% coinsurance. Ambulatory surgical center services require a $475 copay with no coinsurance, outpatient substance abuse sessions carry a $35 copay with no coinsurance, and outpatient blood services have no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Simple (HMO-POS) plan with a $105.00 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $340 copay and no coinsurance, subject to prior authorization. For transportation services, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Wellcare Simple (HMO-POS) with a $115 copay and no coinsurance, and urgent care is available with a $40 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum benefit with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) covers primary care visits and select telehealth services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance (excluding other chiropractic services), therapy and mental health services carry a $35 copay with no coinsurance, and podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) covers preventive services, including annual physicals, fitness benefits, and glaucoma screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Additional preventive services are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and home-based palliative care.
Hearing Services See details
Hearing services are covered by Wellcare Simple (HMO-POS), featuring a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered up to $750 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) partially covers vision services with no coinsurance and no deductibles, though other eye exam services are not covered. Routine eye exams are covered with no copay, and eyewear is covered with no copay up to a $200 annual maximum.
Dental Services See details
Wellcare Simple (HMO-POS) offers partially covered dental services, featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and adjunctive services. Restorative services, endodontics, periodontics, removable and fixed prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay, although prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellcare Simple (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay, although prior authorization is required for these benefits and diabetic supplies must be from specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Wellcare Simple (HMO-POS) with prior authorization, featuring no copay or coinsurance for lab services and a $0 to $75 copay with no coinsurance for diagnostic tests. Diagnostic radiological services require a copay with no coinsurance, outpatient X-rays require a $50 copay and coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under Wellcare Simple (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, meaning some services are covered, though standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy (SET) for symptomatic peripheral artery disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and 71 through 100, a $218 daily copay for days 21 through 70, and additional days beyond the Medicare limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, offering acupuncture with no copay and no coinsurance for up to 12 treatments per year with prior authorization. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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