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Wellcare Giveback (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback (HMO) in 2026, please refer to our full plan details page.
Wellcare Giveback (HMO) is a HMO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in CA. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Giveback (HMO) 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 Giveback (HMO).
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 Giveback (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $39.00. You must continue to pay paying your reduced 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 $6750.00 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 Giveback (HMO) plan features an enhanced alternative drug benefit with a yearly prescription drug deductible of $615.00. After meeting this deductible, Tier 1 preferred generics have no copay at preferred pharmacies and a $10.00 copay at standard pharmacies, while Tier 5 specialty drugs have no copay at either pharmacy type. Other drug tiers require coinsurance during the initial coverage phase, including 25% for standard generics and non-preferred drugs, and 42% for preferred brands. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, individuals who qualify for the low-income subsidy can reduce their Part D cost-sharing to nothing.
Additional Benefits
The Wellcare Giveback (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care, specialist visits, and preventive services. For emergency care, members pay a $130 copay with no coinsurance, while urgent care visits require a low $25 copay. Inpatient hospital stays are covered with no coinsurance, though they require a $325 daily copay for the first eight days of acute care. This plan also provides excellent everyday health benefits, offering routine dental, vision, and hearing exams with no copays or coinsurance. Vision eyewear is covered with no copay up to $100 annually, and hearing aids are covered up to $350 per ear with no copay. Additionally, home health services and diabetic supplies are fully covered with no copay, while durable medical equipment requires a 20% coinsurance.
Inpatient Hospital See details
Wellcare Giveback (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1-8 of acute care (no copay for days 9-110) and a $290 daily copay for days 1-8 of psychiatric care (no copay for days 9-90). Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Giveback (HMO) with no coinsurance, featuring copays ranging from no copay to $375 for hospital services and $130 to $375 per stay for observation services. Patients will also pay a $350 copay for ambulatory surgical center services, a $25 copay for outpatient substance abuse sessions, and no copay for outpatient blood services.
Partial Hospitalization See details
Wellcare Giveback (HMO) covers partial hospitalization benefits with a $140.00 copay and no coinsurance. Prior authorization and a doctor referral are required for these covered services.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO) covers ground and air ambulance services with a $275 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 Giveback (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum benefit with a $130 copay, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback (HMO) offers primary care, specialist, and podiatry visits with no copay or coinsurance, while physical and occupational therapy require a $10 copay and no coinsurance. Mental health and psychiatric services have a $25 copay and no coinsurance, and chiropractic benefits are partially covered, as routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Wellcare Giveback (HMO), offering annual physicals, alternative therapies, and screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, home safety devices, and counseling services are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Giveback (HMO), offering routine exams, fittings, and general prescription hearing aids with no copay and no coinsurance, up to a $350 annual maximum per ear. However, OTC hearing aids and specific prescription hearing aid types—including inner ear, outer ear, and over the ear—are not covered.
Vision Services See details
Vision services are covered by Wellcare Giveback (HMO) with no copay, no coinsurance, and no deductible, including one routine eye exam every year. Eyewear, including contacts, eyeglasses, and upgrades, is also covered with no copay or coinsurance up to a combined maximum limit of $100 annually.
Dental Services See details
Wellcare Giveback (HMO) partially covers dental services, offering covered preventive and comprehensive care with no copays or coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Giveback (HMO) with prior authorization required. Under this plan, Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Giveback (HMO) covers dialysis services with no copay and a 20% coinsurance. A doctor referral is required to receive these covered services.
Medical Equipment See details
Wellcare Giveback (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic therapeutic shoes, for a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, though prior authorization is required for most medical equipment services.
Diagnostic and Radiological Services See details
Wellcare Giveback (HMO) covers diagnostic and radiological services, though prior authorization and a doctor referral are required. Lab services and outpatient X-rays feature no copay and no coinsurance, while other diagnostic tests require a $0 to $25 copay (no coinsurance), diagnostic radiology ranges from a $0 to $375 copay (no coinsurance), and therapeutic radiology has a 20% coinsurance with no copay.
Home Health Services See details
Wellcare Giveback (HMO) covers home health services with no copay and no coinsurance. A doctor referral and prior authorization are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Giveback (HMO) plan, as all individual sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered. Since these services are not covered, there are no associated copays or coinsurance costs.
Skilled Nursing Facility (SNF) See details
Wellcare Giveback (HMO) partially covers Skilled Nursing Facility (SNF) services with no copay for days 1 to 20 and days 61 to 100, a $218 daily copay for days 21 to 60, and no coinsurance. Prior authorization and a doctor referral are required, but additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
Other Services are not covered under the Wellcare Giveback (HMO) plan, as acupuncture, over-the-counter (OTC) items, meal benefits, and dual eligible SNPs are all excluded from coverage. Since these benefits are not covered by the plan, there are no copay or coinsurance options available, and members must pay the full cost out of pocket.
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