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Wellcare Assist (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO) in 2025, please refer to our full plan details page.
Wellcare Assist (HMO) is a HMO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in TX. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Assist (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 Assist (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 Assist (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.20. 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 $580.00 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 $3450.00 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) plan has a $580 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For the initial coverage phase, preferred generic drugs have a $19 copay at preferred pharmacies, and preferred brand drugs have a $100 copay. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Assist (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, but some days have no copay, and outpatient services have copays depending on the service. The plan also covers ambulance services with a copay, and offers transportation to health-related locations with no copay for up to 24 one-way trips per year. The plan includes no copay for primary care physician visits and many preventive services. It also covers hearing, vision, and dental services, with specific copays and maximum annual benefits for some services. The plan also offers coverage for home infusion, dialysis, medical equipment, and other services, including over-the-counter items and meal benefits.
Inpatient Hospital See details
The Wellcare Assist (HMO) plan covers inpatient hospital stays, including acute and psychiatric care. For days 1-6, there is a $275 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $280, Observation Services have a copay between $140 and $280, Ambulatory Surgical Center Services have a $150 copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $25. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist (HMO) plan with a $130 copay, and prior authorization is required.
Ambulance and Transportation Services See details
The Wellcare Assist (HMO) plan covers ambulance services with a $250 copay for both ground and air ambulance services, and transportation services with no copay for plan-approved health-related locations, up to 24 one-way trips per year. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services with the Wellcare Assist (HMO) plan include a $140 copay, while Urgently Needed Services have a $35 copay, and there is no coinsurance for either. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, but Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $20 copay, but Routine Chiropractic Care is not covered. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services each have a $20 copay. Mental Health and Psychiatric Services each have a $25 copay for individual and group sessions. Other Health Care Professional services have a copay between $0 and $20. Additional Telehealth Benefits have a copay between $0 and $35. Opioid Treatment Program Services have a $20 copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, while other services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 Benefit, 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. The plan offers a 20% coinsurance for Kidney Disease Education Services. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services includes 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 up to $750 per year, with no copay for Prescription Hearing Aids (all types), but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Assist (HMO) plan covers vision services including eye exams with a copay between $0 and $20, and eyewear, with no copay and a combined maximum benefit of $300 per year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, and other services such as oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Orthodontic Services are covered up to a maximum of $3,000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Wellcare Assist (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, while 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) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying coinsurance and copay costs, and Diabetic Supplies with no copay. 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 Assist (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $280, while Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a copay of $50.
Home Health Services See details
Home Health Services are covered under the Wellcare Assist (HMO) 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 not covered by the Wellcare Assist (HMO) plan. While the plan covers some Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay; for days 21-40, the copay is $214; and for days 41-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits. OTC items have no copay, with a maximum plan benefit of $120 every three months, and Meal Benefits have no copay and require a doctor's referral. Acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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