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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 $600.00 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 $3900.00 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 $600. For Tier 1 preferred generics and Tier 2 generics, copayments start as low as $18 and $19 respectively for a one-month supply, with no copay required for a three-month supply filled via preferred mail order. Tier 6 select care drugs also offer no copay when using preferred pharmacies or preferred mail order. Higher-tier medications on this plan require coinsurance instead of a flat copay. Tier 3 preferred brands carry a 20% coinsurance, Tier 4 non-preferred drugs require 38% coinsurance, and Tier 5 specialty drugs have a 25% coinsurance for a one-month supply. Utilizing preferred network pharmacies and mail-order services can help you minimize your out-of-pocket expenses.
Additional Benefits
The Wellcare Assist (HMO) plan offers affordable medical coverage featuring no copays and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $325 copay per day for days one through six and no copay for subsequent days, while outpatient hospital services range from no copay up to a $300 copay. Emergency care is available with a $150 copay, which is waived if you are admitted, and urgent care requires a $40 copay. This plan also includes valuable supplemental benefits, such as dental and vision care with no copays for routine services up to set annual limits, and routine hearing exams with no copay alongside a $350 annual allowance per ear for prescription hearing aids. Additionally, skilled nursing facility stays offer no copay for the first 20 days, and select over-the-counter items are fully covered with no copay. While most services feature no coinsurance, a standard 20% coinsurance applies to dialysis and durable medical equipment.
Inpatient Hospital See details
Wellcare Assist (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $325 copay for days 1 to 6 and no copay for days 7 to 95. Inpatient psychiatric care is also covered with no coinsurance, featuring a $225 copay for days 1 to 7 and no copay for days 8 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Assist (HMO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $150 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay, while outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Wellcare Assist (HMO) plan with a $175.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Assist (HMO) covers ground and air ambulance services with a $250 copay per service and no coinsurance, subject to prior authorization. While transportation services are technically covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services under Wellcare Assist (HMO) are covered with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a maximum plan benefit of $50,000 with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $20 copay and no coinsurance. Mental health and psychiatric sessions have a $25 copay and no coinsurance, but routine chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under Wellcare Assist (HMO), offering annual physical exams, select screenings, and fitness benefits with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, though supplemental services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Assist (HMO) hearing services are partially covered, offering Medicare-covered exams for a $20 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $350 per ear annually with no copay or coinsurance, although OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Wellcare Assist (HMO), offering one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contact lenses, eyeglasses, frames, and upgrades, also features no copay and no coinsurance up to a $100 annual maximum.
Dental Services See details
Wellcare Assist (HMO) dental benefits are partially covered, offering Medicare-covered dental services for a $20 copay and no coinsurance, alongside preventive and other comprehensive services with no copay and no coinsurance up to a $1,000 annual limit. However, fixed and removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by Wellcare Assist (HMO) with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellcare Assist (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay. A 20% coinsurance applies to DME, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts, and prior authorization is required.
Diagnostic and Radiological Services See details
Wellcare Assist (HMO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance and copays ranging from $0 to $50 for diagnostic tests and lab services. Radiological services include outpatient X-rays with a $50 copay, therapeutic services with a minimum 20% coinsurance, and diagnostic radiology with copays starting at $0.
Home Health Services See details
Wellcare Assist (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Wellcare Assist (HMO) with no coinsurance, though only some services are covered. Standard cardiac rehabilitation ($50 copay), intensive cardiac rehabilitation ($65 copay), pulmonary rehabilitation ($40 copay), and SET for PAD services ($30 copay) are not 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 41 to 100, and a $218 daily copay for days 21 to 40. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Assist (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance via reimbursement, which includes nicotine replacement therapy and naloxone. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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