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Wellcare Patriot Simple (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Patriot Simple (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Patriot Simple (HMO) in 2026, please refer to our full plan details page.
Wellcare Patriot Simple (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 Patriot Simple (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Patriot Simple (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 Patriot Simple (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.
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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 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
Prescription drugs are not covered by Wellcare Patriot Simple (HMO).
Additional Benefits
The Wellcare Patriot Simple (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits, mental health services, and routine preventive care. For specialist visits and physical therapy, you will pay a low $10 copay, while inpatient hospital stays require a daily copay for the first five days with no copay thereafter. Outpatient procedures and diagnostic lab services are also highly affordable, often requiring no copay or low flat copayments with no coinsurance. This plan also includes valuable supplemental benefits, such as no copay for preventive dental, routine vision, and annual hearing exams, along with generous annual allowances for eyewear and hearing aids. Additionally, members benefit from no copay on home health services and over-the-counter items, while specialized services like dialysis and durable medical equipment carry a standard 20% coinsurance. Emergency care is accessible worldwide with a flat copay, ensuring comprehensive protection wherever you are.
Inpatient Hospital See details
Wellcare Patriot Simple (HMO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $275 for days 1 through 5 of acute stays and $225 for days 1 through 5 of psychiatric stays, followed by no copay for remaining covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Patriot Simple (HMO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $200 for outpatient hospital services and $150 to $200 per stay for observation services. Ambulatory surgical center services require a $125 copay with no coinsurance, while outpatient substance abuse and blood services are covered with no copays and no coinsurance.
Partial Hospitalization See details
Wellcare Patriot Simple (HMO) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Wellcare Patriot Simple (HMO) covers ground and air ambulance services with a $225 copay per service and no coinsurance, subject to prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Patriot Simple (HMO) emergency services are covered with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services require a $25 copay with no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum benefit with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Patriot Simple (HMO) covers primary care doctor visits and mental health services with no copay and no coinsurance. Specialist visits, physical therapy, and occupational therapy are covered with a $10 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Patriot Simple (HMO) partially covers preventive services, offering annual physical exams, glaucoma screenings, and diabetes self-management with no copay and no coinsurance, while kidney disease education has no copay but requires a 20% coinsurance. Additional benefits like memory fitness, alternative therapies, and personal emergency response systems feature no copay and no coinsurance, but several services including nutrition therapy, health education, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Patriot Simple (HMO) with no coinsurance or deductibles, featuring a $10 copay for Medicare-covered exams and no copay for annual routine exams and fittings. Prescription hearing aids are covered with no copay up to $750 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 Patriot Simple (HMO) with no coinsurance, though other eye exam services are not covered. Routine eye exams have no copay, other covered exams have a copay of up to $10.00, and eyeglasses, contact lenses, and upgrades have no copay and no coinsurance up to a $300 annual limit.
Dental Services See details
Dental services are partially covered by Wellcare Patriot Simple (HMO), featuring a $10 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most preventive and comprehensive services up to a $3,000 annual limit. Prior authorization is required for most services, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Patriot Simple (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are available with no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellcare Patriot Simple (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Patriot Simple (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Patriot Simple (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures and lab services have no copay and no coinsurance, while diagnostic radiological services have a $0 minimum copay, outpatient X-rays require a $25 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Wellcare Patriot Simple (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Patriot Simple (HMO) offers cardiac rehabilitation services with no coinsurance, meaning some services are covered, though cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. These non-covered services require copayments of $50.00, $65.00, $40.00, and $30.00, respectively.
Skilled Nursing Facility (SNF) See details
Wellcare Patriot Simple (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, featuring no copay for days 1 to 20 and days 41 to 100, and a $218 daily 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
Wellcare Patriot Simple (HMO) provides partial coverage for Other Services, which includes over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. However, acupuncture is not covered under this plan.
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