A non-government entity
Wellcare Simple (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple (HMO) in 2026, please refer to our full plan details page.
Wellcare 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 Simple (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 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 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.
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 $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:
Sign up for Wellcare Simple (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple (HMO) prescription drug plan features an annual drug deductible of $615. You can enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when using a preferred pharmacy or preferred mail order. Standard pharmacies offer these tier-one and tier-two medications with copays starting at $5 and $10, respectively. For higher-tier prescriptions, cost-sharing is based on coinsurance. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs require 34% coinsurance at preferred pharmacies and 35% coinsurance at standard pharmacies. This straightforward tier structure makes it easy to project your monthly medication costs under this Wellcare plan.
Additional Benefits
The Wellcare Simple (HMO) plan offers robust healthcare coverage with no copays for primary care visits, preventive services, annual routine hearing and vision exams, and home health care. Members also benefit from no copays on preventive dental services up to a $1,000 annual limit, routine eyewear up to $200, and over-the-counter items. Specialist visits are highly affordable with a $25 copay, while urgent care and emergency services require copays of $35 and $150, respectively. For inpatient hospital care, the plan features a daily copay of $350 for the first six days of acute stays, followed by no copay for additional Medicare-covered days. Outpatient services, diagnostic tests, and skilled nursing facility stays generally feature no coinsurance, though daily copays may apply depending on the length and type of service. Durable medical equipment, dialysis, and select Part B drugs require a standard 20% coinsurance with no copay.
Inpatient Hospital See details
Wellcare Simple (HMO) partially covers inpatient hospital care with no coinsurance, requiring prior authorization. Acute stays require a $350 daily copay for days 1 to 6 (no copay for days 7 to 90), and psychiatric stays require a $325 daily copay for days 1 to 6 (no copay for days 7 to 90), though additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO) covers outpatient services with no coinsurance, featuring copays of $0 to $400 for hospital services, $150 to $400 per stay for observation, and $250 for ambulatory surgical center services. Outpatient substance abuse sessions require a $30 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple (HMO) with a $175.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellcare Simple (HMO), with ground and air ambulance services requiring prior authorization, a $275 copay, and no coinsurance. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Wellcare Simple (HMO) covers emergency services with a $150 copay and urgently needed services with a $35 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 limit with a $150 copay and no coinsurance for emergency and urgent care, while worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $25 copay with no coinsurance. Other covered benefits, including physical, occupational, and mental health therapies, carry a $30 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Simple (HMO) covers preventive services, including annual physical exams, memory fitness, and alternative therapies with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, though several supplemental benefits such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services under Wellcare Simple (HMO) are partially covered, featuring a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams, fittings, and prescription hearing aids up to $500 per ear. Over-the-counter (OTC) hearing aids, alongside inner-ear, outer-ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Wellcare Simple (HMO) partially covers vision services with no copay and no coinsurance, providing one routine eye exam per year and up to $200 annually for eyewear, though prior authorization is required. Other eye exam services are not covered under this plan.
Dental Services See details
Wellcare Simple (HMO) partially covers dental services, featuring Medicare-covered dental with a $25 copay and no coinsurance, plus preventive and select comprehensive services with no copay and no coinsurance up to a $1,000 annual maximum. Prosthodontics, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Wellcare Simple (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO) with prior authorization required. Diagnostic tests have no coinsurance and a $0 to $30 copay, lab services have no copay or coinsurance, and radiological services range from a $0 minimum copay for diagnostic imaging to a $50 copay with coinsurance for X-rays and a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Wellcare Simple (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 by Wellcare Simple (HMO) with no coinsurance, though only some services are covered as standard cardiac rehabilitation ($50 copay), intensive cardiac rehabilitation ($65 copay), pulmonary rehabilitation ($40 copay), and supervised exercise therapy for peripheral artery disease ($30 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering 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 needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services covered under the Wellcare Simple (HMO) plan include over-the-counter (OTC) items and chronic illness meal benefits, both of which feature no copay and no coinsurance. Acupuncture is not covered under this plan, and a referral is required to access the meal benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved