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Wellcare Low Premium (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Low Premium (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Low Premium (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Low Premium (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in MI. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Low Premium (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 Low Premium (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 Low Premium (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.00. 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 $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 $4800.00 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 Low Premium (HMO-POS)
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Drug Coverage
The Wellcare Low Premium (HMO-POS) plan has a $420 deductible for prescription drugs. In the initial coverage phase, after the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at preferred pharmacies and a $10 copay at standard pharmacies. For preferred brand drugs, you pay 36% coinsurance regardless of the pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Low Premium (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary based on the service. The plan also covers ambulance and emergency services, with copays for each. This plan includes coverage for primary care, hearing, vision, and dental services, with varying copays. The plan also covers home health, skilled nursing facilities, and medical equipment. Additionally, the plan offers other services such as over-the-counter items and a meal benefit with no copays.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $300 copay for days 1-7, and no copay for days 8-90 for Inpatient Hospital-Acute, and a $296 copay for days 1-7, and no copay for days 8-90 for Inpatient Hospital Psychiatric. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $275, while Observation Services have a copay between $125 and $275. Ambulatory Surgical Center Services have a $125 copay, and outpatient substance abuse services have a $40 copay for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Low Premium (HMO-POS) plan, but requires prior authorization. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Low Premium (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 for up to 12 one-way trips per year; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered under the Wellcare Low Premium (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $40 copay; all three have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Low Premium (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, and physical therapy and speech-language pathology services with a $25 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions. The plan also covers other health care professionals with a copay between $0 and $25. Additional telehealth benefits have a copay between $0 and $40, and opioid treatment program services have a $25 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. The plan also covers Personal Emergency Response Systems and Alternative Therapies with no copay, as well as Kidney Disease Education Services with 20% coinsurance. Health Education, In-Home Safety Assessments, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefits, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The Wellcare Low Premium (HMO-POS) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $750 per year, and two visits per year, with no copay.
Vision Services See details
The Wellcare Low Premium (HMO-POS) plan covers vision services including eye exams and eyewear. Eye exams have a copay of $0-$25, while routine eye exams have no copay. Eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all have no copay.
Dental Services See details
The Wellcare Low Premium (HMO-POS) plan covers Medicare Dental Services with a $25 copay. Other dental services include oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatment, restorative services, and more, all with no copay. This plan offers a $5,000 maximum benefit for orthodontic services. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including insulin and other Medicare Part B drugs. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Low Premium (HMO-POS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Low Premium (HMO-POS) plan, with Durable Medical Equipment (DME) subject to a 20% coinsurance and Diabetic Supplies covered with no copay. Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts are covered, each with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, diagnostic procedures and tests with a copay between $0 and $50, lab services with no copay, diagnostic radiological services with a copay up to $275, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $25 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Wellcare Low Premium (HMO-POS) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Low Premium (HMO-POS) plan. The plan 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, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Low Premium (HMO-POS) plan. For days 1-20, and days 51-100, there is no copay, while days 21-50 have a copay of $214.
Other Services See details
Other Services includes coverage for over-the-counter items with no copay, and a meal benefit with no copay, but acupuncture, dual eligible SNPs, 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 are not covered. The over-the-counter benefit has a maximum coverage amount of $72 every three months.
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