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Wellcare Giveback (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback (HMO) in 2025, please refer to our full plan details page.
Wellcare Giveback (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 Giveback (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 Giveback (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 Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $57.60. You must continue to pay paying your reduced 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 $420.00 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 $7550.00 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 Giveback (HMO) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs and specialty tier drugs, there is no copay. Standard generic drugs have a 25% coinsurance, while preferred brand drugs have a 44% coinsurance. Non-preferred drugs have a 28% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Giveback (HMO) plan offers a range of benefits with varying cost-sharing. You can expect no copay for primary care, preventive services like annual physical exams, and many vision and dental services. Additionally, this plan has no copay for Home Health Services and offers coverage for OTC items with a $45 allowance every three months. The plan has copays for inpatient hospital stays, outpatient services, and emergency services. Costs vary depending on the service, with copays for specialist visits, mental health, and physical therapy. The plan also includes coverage for hearing aids and eyewear, and offers services like ambulance, dialysis, and medical equipment, with some services subject to coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $478 per admission for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $370 per admission for days 1-5, and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $425, observation services with a copay between $110 and $425, ambulatory surgical center services with a $375 copay, and outpatient substance abuse services with a $25 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Giveback (HMO) plan with a $80 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Giveback (HMO) plan. Ground and Air Ambulance Services have a $300 copay, with no coinsurance, but Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare Giveback (HMO) plan. Emergency Services has a $110 copay, while Urgently Needed Services has a $45 copay, and Worldwide Emergency Coverage has a $110 copay. Worldwide Urgent Coverage is also covered with a $110 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Giveback (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services with a $50 copay, individual and group mental health sessions with a $25 copay, and physical therapy and speech-language pathology services with a $35 copay. Additionally, the plan offers telehealth benefits with a copay ranging from $0 to $50, and Opioid Treatment Program Services with a $50 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Other preventive services include Medicare-covered glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered. Routine hearing exams and fitting/evaluation for hearing aids have no copay, while hearing exams have a $50 copay. Prescription hearing aids (all types) are covered with no copay, but inner ear, outer ear, and over the ear prescription hearing aids are not covered; OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $50, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and have a combined maximum benefit of $100 per year.
Dental Services See details
The Wellcare Giveback (HMO) plan covers Medicare Dental Services with a $50 copay, and offers Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services with no copay. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
The Wellcare Giveback (HMO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Giveback (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance with prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellcare Giveback (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, Lab Services have no copay, and Diagnostic Radiological Services have a copay up to $425. 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 Giveback (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but all of the sub-services are not covered. The plan does not specify any cost-sharing details for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Giveback (HMO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, and for days 21-60, the copay is $214.
Other Services See details
Other services include coverage for over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $45 every three months. Acupuncture, meal benefits, and several other services are not covered.
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