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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 2026, 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 2026.
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 $4.80. 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 $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 $3700.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 6 select care drugs, members pay no copay at any network pharmacy or mail-order service. Tier 1 preferred generic and Tier 2 generic drugs offer low copays starting at $18 and $19 respectively, with no copay for a three-month supply filled through preferred mail order. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copays. You will pay 20% coinsurance for Tier 3 preferred brands, 37% coinsurance for Tier 4 non-preferred drugs, and 25% coinsurance for Tier 5 specialty drugs. These coinsurance rates apply at both preferred and standard pharmacies, as well as through mail-order options.
Additional Benefits
The Wellcare Assist (HMO) plan offers robust medical coverage with no copay for primary care doctor visits and a $20 copay for specialist appointments. For inpatient hospital stays, members pay a $275 daily copay for days 1 through 6 and no copay for days 7 through 90. Emergency room visits require a $150 copay, which is waived if you are admitted to the hospital within 24 hours. Additional benefits include preventive dental care, routine hearing exams, and routine vision exams with no copay, plus annual allowances of up to $2,000 for comprehensive dental and $300 for eyewear. Members also receive up to 12 one-way transportation trips to approved health locations and select over-the-counter items with no copay. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Assist (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $275 daily copay for days 1 through 6 and no copay for days 7 through 90. The benefit is partially covered, as hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Assist (HMO) with no coinsurance, featuring copays ranging from no copay to $280 for outpatient hospital services and a $150 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare Assist (HMO) covers partial hospitalization services with a $175 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Assist (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance per trip, subject to prior authorization. Transportation benefits are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Wellcare Assist (HMO) covers emergency services with a $150 copay and urgently needed services with a $35 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and speech therapy require a $20 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have copays ranging from $20 to $25 with no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Wellcare Assist (HMO) covers preventive services, including annual physical exams, select fitness benefits, and remote access technologies, with no copay and no coinsurance, while kidney disease education has no copay but a 20% coinsurance. This benefit is partially covered, as services such as health education, in-home safety assessments, personal emergency response systems, and nutritional counseling are not covered.
Hearing Services See details
Wellcare Assist (HMO) covers hearing services, including Medicare-covered exams for a $20 copay and no coinsurance, and routine exams and fittings with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Assist (HMO) as other eye exam services are not covered. Covered eye exams require a $0 to $20 copay and no coinsurance, while covered eyewear has no copay and no coinsurance up to a $300 annual maximum with no deductible.
Dental Services See details
Dental services are partially covered by Wellcare Assist (HMO), with a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and most comprehensive services up to a $2,000 yearly maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Assist (HMO) covers Home Infusion bundled Services with no copay, requiring prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Assist (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist (HMO) covers medical equipment, including 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) with prior authorization required. Diagnostic services carry no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $50 copay. Radiological services require a $50 copay and coinsurance for X-rays, a minimum 20% coinsurance and a copay for therapeutic services, and a copay starting at $0 with no coinsurance for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by Wellcare Assist (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Assist (HMO) plan, and there are no applicable copays or coinsurance because none of the individual rehabilitation services are covered.
Skilled Nursing Facility (SNF) See details
Wellcare Assist (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 41 to 100, and a $218 copay for days 21 to 40. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under Wellcare Assist (HMO) are partially covered, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though meals require a referral. Acupuncture and other additional services under this category are not covered.
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