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Wellcare Complete Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Complete Simple (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Complete Simple (HMO-POS) in 2025, please refer to our full plan details page.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Complete Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for the 2025 plan year to people living in Select counties in Kansas. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Complete Simple (HMO-POS) 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 Complete Simple (HMO-POS).
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 Complete Simple (HMO-POS), 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
Health deductible: information not available.
This plan has a $420.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3200.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $3200.00 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 Complete Simple (HMO-POS) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay for your prescriptions based on the drug tier and the pharmacy you use. For preferred generic drugs and specialty tier drugs, there is no copay. For standard generic drugs, you pay 25% coinsurance. For preferred brand drugs, you pay 38% coinsurance, and for non-preferred drugs, you pay 28% coinsurance. After your total drug costs reach $2000, you pay nothing for covered Part D drugs.
Additional Benefits
The Wellcare Complete Simple (HMO-POS) plan offers a variety of benefits, including inpatient hospital stays with copays that vary by length of stay, and outpatient services with copays ranging from $0 to $280. This plan also covers ambulance services with a $250 copay, and transportation services to health-related locations with no copay. Additional services include primary care with no copay, along with hearing, vision, and dental coverage with varying copays and coinsurance, as well as coverage for home health services with no copay. Preventive services, like an annual physical exam, are covered with no copay, and the plan also provides coverage for durable medical equipment, and home infusion services with varying copays and coinsurance. This plan also covers emergency services, and offers coverage for skilled nursing facilities with no copay for the first 20 days and days 41-100, but other services may have a copay or coinsurance, such as diagnostic services, cardiac rehabilitation, and dialysis services. The plan includes an over-the-counter allowance of up to $200 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Inpatient Hospital-Acute has a $350 copay for days 1-7, and no copay for days 8-90, while Inpatient Hospital Psychiatric has a $300 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute has no copay for days 91-120.
Outpatient Services See details
Outpatient Services include coverage for 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 $200 copay. This plan also covers individual and group sessions for outpatient substance abuse with a copay of $30, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Complete Simple (HMO-POS) 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 Complete Simple (HMO-POS) plan. Ground and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $140, $30, and $140, respectively, with no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Complete Simple (HMO-POS) plan covers primary care physician services with no copay and chiropractic services with a $20 copay. Occupational therapy services have a $30 copay, while physician specialist services have a $25 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions. Podiatry services have a $25 copay, and other health care professional services have a copay between $0-$25. Physical therapy and speech-language pathology services have a $30 copay, and opioid treatment program services have a $25 copay. Additional telehealth benefits range from no copay to a $30 copay.
Preventive Services See details
The Wellcare Complete Simple (HMO-POS) plan covers preventive services, including an annual physical exam with no copay, as well as additional preventive services, with a copay for some services. Kidney disease education services have a 20% coinsurance. Other preventive services, such as glaucoma screenings and diabetes self-management training, are covered with no copay.
Hearing Services See details
The Wellcare Complete Simple (HMO-POS) plan covers hearing exams for a $25 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids (all types) are covered with a maximum benefit of $350 per year, with no copay. However, OTC hearing aids, and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Wellcare Complete Simple (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $25, and eyewear with a combined maximum benefit of $300 per year and no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams have no copay and are limited to one per year.
Dental Services See details
The Wellcare Complete Simple (HMO-POS) plan covers Medicare Dental Services with a $25 copay, and also covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, and other preventive dental services with no copay, but some of these services are limited to a certain number of visits per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 40% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Complete Simple (HMO-POS) plan. 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 under the Wellcare Complete Simple (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered by the Wellcare Complete Simple (HMO-POS) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Complete Simple (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $280, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $75 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Complete Simple (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Wellcare Complete Simple (HMO-POS) partially covers Cardiac Rehabilitation Services, but does not cover 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. There is a copay for the covered services, but the details of the copay are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, with no copay for days 1-20 and 41-100, but a $214 copay for days 21-40. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for the Wellcare Complete Simple (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, up to $200 every three months, and does not cover acupuncture, meal benefits, 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.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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