A non-government entity
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 2026, 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 2026.
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 $40.00. 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 $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 $8200.00 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 Giveback (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 Giveback (HMO) prescription drug plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications when filled at a preferred pharmacy or through preferred mail order. Additionally, Tier 6 select care drugs are highly accessible with no copay at both preferred and standard pharmacies. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 42% coinsurance. Standard pharmacies are also available but will require copays ranging from $5 to $30 for Tier 1 and Tier 2 medications depending on the supply.
Additional Benefits
The Wellcare Giveback (HMO) plan provides comprehensive coverage for everyday healthcare needs with predictable out-of-pocket costs. Members pay no copay and no coinsurance for primary care physician visits, home health services, and annual physical exams, while specialist visits require a $50 copay. Inpatient hospital stays require a copay for the first five days but have no coinsurance and no copay for subsequent days. Supplemental benefits like dental, vision, and hearing services are also covered with no deductible and no coinsurance. You can receive routine eye exams, eyewear up to a $100 yearly limit, routine hearing evaluations, and preventive dental services with no copay. Additionally, over-the-counter items are available with no copay, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Wellcare Giveback (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $475 copay for days 1 through 5 and no copay for days 6 through 95. Inpatient psychiatric care is also covered with no coinsurance, requiring a $370 copay for days 1 through 5 and no copay for days 6 through 90, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Giveback (HMO) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $450, while ambulatory surgical center services require a $375 copay and no coinsurance. Outpatient substance abuse sessions have a $25 copay with no coinsurance, and outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare Giveback (HMO) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Wellcare Giveback (HMO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback (HMO) covers primary care physician services with no copay and no coinsurance, while telehealth services have a $0 to $50 copay and no coinsurance. Specialist visits require a $50 copay, physical and occupational therapy services cost $35, and mental health sessions are $25, all with no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services under the Wellcare Giveback (HMO) plan are partially covered, offering annual physical exams, memory fitness, remote access, and various screenings with no copay and no coinsurance. Kidney disease education is covered with no copay but requires a 20% coinsurance, while several supplemental services such as health education, weight management, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Giveback (HMO) covers hearing services with no deductible and no coinsurance, featuring Medicare-covered exams for a $50 copay and routine exams or fitting evaluations for no copay. Prescription hearing aids are partially covered with no copay up to $350 per ear yearly, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Giveback (HMO) with no deductibles and no coinsurance, though prior authorization is required. One annual routine eye exam and eyewear—including contacts, eyeglasses, and upgrades up to a $100 yearly limit—are available with no copay, while other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Wellcare Giveback (HMO), featuring a $50 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and adjunctive services. Restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Giveback (HMO) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance and no copay, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Giveback (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Giveback (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are offered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Giveback (HMO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance for diagnostic services alongside no copay for labs and a $0 to $50 copay for diagnostic procedures. Radiological services include a $50 copay and coinsurance for outpatient X-rays, a $0 minimum copay with no coinsurance for diagnostic radiology, and a minimum 20% coinsurance plus a copay for therapeutic radiology.
Home Health Services See details
Wellcare Giveback (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Giveback (HMO) indicates some cardiac rehabilitation services are covered with no coinsurance, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice. These uncovered services require copayments ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Wellcare Giveback (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance and requires prior authorization, without requiring a prior three-day hospital stay. There is no copay for days 1 to 20 and days 61 to 100, but a $218 daily copay applies for days 21 to 60; additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Giveback (HMO) partially covers Other Services, providing over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture and meal benefits are not covered.
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