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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 $18.30. 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 $570.00 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 $570.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $19.00 copay for preferred generic drugs at a preferred pharmacy, and 23% coinsurance for standard generic drugs at a preferred pharmacy. Once your total drug costs reach $2000.00, you will 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 cost-sharing. The plan covers inpatient hospital stays with a copay, and outpatient services with copays ranging from $0 to $280. Emergency and urgent care services have copays, while primary care, preventive, and home health services have no copay. Additional benefits include coverage for hearing, vision, and dental services with varying copays and coverage limits. The plan also covers ambulance and transportation services, home infusion, and skilled nursing facility stays with associated copays or coinsurance. However, some services like additional hours of care, private duty nursing, and certain rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you'll pay a $275 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you'll pay a $225 copay for days 1-7, and no copay for days 8-90. Additional days, non-Medicare covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $280, observation services with a copay between $140 and $280, and ambulatory surgical center services with a $150 copay. Outpatient substance abuse services are covered with a copay of $25 for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist (HMO) plan, but requires prior authorization. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Assist (HMO) plan. Ground and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location have no copay for up to 24 one-way trips per year via rideshare, bus/subway, or medical transport. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services under the Wellcare Assist (HMO) plan include a $140 copay and no coinsurance, while Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay (routine care not covered), occupational therapy services with a $20 copay, and physician specialist services with a $20 copay. The plan also covers mental health specialty services with a $25 copay for individual and group sessions, and other health care professional services with a copay between $0 and $20. The plan covers psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $20 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams with no copay, and additional preventive services with no copay for services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. The plan has a 20% coinsurance for Kidney Disease Education Services.
Hearing Services See details
Wellcare Assist (HMO) covers hearing exams with a $20 copay, as well as routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $1000 per year, though specific types of hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services, including services not usually covered by Medicare plans, are covered under the Wellcare Assist (HMO) plan. Eye exams have a copay between $0 and $20, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay and a combined maximum plan benefit of $300 every year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $20 copay, 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 prosthodontics, fixed with no copay. Orthodontic services are covered up to a maximum of $3,000 per year, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Assist (HMO) plan, with prior authorization required. 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 between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
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, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $245, while Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home health services are covered by 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 covered by the Wellcare Assist (HMO) plan. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will have no copay for days 1-20, a $214 copay for days 21-40, and no copay for days 41-100.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits, with a $0 copay for OTC items. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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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