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Wellcare Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 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 Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Simple (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 2026.
It's important to know that Wellcare 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 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 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
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 $5000.00 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 Simple (HMO-POS) Medicare plan features an annual prescription drug deductible of $615. Beneficiaries can save on prescription costs with no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filled at a preferred pharmacy. Standard pharmacies and standard mail-order services are also available with low copays starting at $5. For higher-tier medications, coverage transitions to a percentage-based coinsurance. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs have a 49% coinsurance at both preferred and standard pharmacies.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care physician visits, home health services, and routine preventive care. For specialist visits, members pay a low $25 copay, while inpatient hospital stays require a daily copay for the first seven days and no copay thereafter. Outpatient procedures and emergency room services are also covered with no coinsurance, featuring copays up to $280 and $130 respectively. Additionally, this plan provides robust dental, vision, and hearing benefits with no copay for preventive care, alongside allowances for eyewear and prescription hearing aids. While lab tests and over-the-counter items are available with no copay, durable medical equipment and dialysis services require a 20% coinsurance. Members can also benefit from up to 12 one-way transportation trips per year to plan-approved locations with no copay or coinsurance.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $400 copay for days 1 to 7 (no copay for days 8 to 90) for acute stays, and a $325 copay for days 1 to 7 (no copay for days 8 to 90) for psychiatric stays. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) outpatient services are covered with no coinsurance, featuring outpatient hospital copays ranging from no copay up to $280 and ambulatory surgical center services for a $175 copay. Outpatient substance abuse sessions require a $40 copay with no coinsurance, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $140 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, though transport to any health-related location is not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $45 copay, with no coinsurance for either service and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are also covered up to a $50,000 maximum plan benefit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) offers primary care physician services with no copay and no coinsurance, and specialist visits for a $25 copay and no coinsurance. Physical therapy, occupational therapy, and mental health services are covered with copays ranging from $30 to $40 and no coinsurance; however, podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Wellcare Simple (HMO-POS) covers annual physical exams, fitness benefits, alternative therapies, remote access technologies, and various screenings with no copay and no coinsurance, though kidney education services require a 20% coinsurance with no copay. Additional preventive services are only partially covered; excluded services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling.
Hearing Services See details
Wellcare Simple (HMO-POS) provides partially covered hearing services, including Medicare-covered exams for a $25 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Simple (HMO-POS), featuring eye exams with a $0 to $25 copay and no coinsurance, alongside eyewear with no copay and no coinsurance. While routine eye exams are covered once yearly and eyewear has a $300 annual maximum benefit, other eye exam services are not covered.
Dental Services See details
Dental Services are partially covered by Wellcare Simple (HMO-POS), offering Medicare-covered dental services for a $25 copay and no coinsurance, alongside preventive and most comprehensive services with no copay and no coinsurance up to a $3,000 annual limit. Prior authorization is required for most services, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy 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-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered 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 Simple (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance and diagnostic tests with no coinsurance and copays ranging from $0 to $100. Outpatient X-rays require a $45 copay and coinsurance, diagnostic radiology starts with no copay, and therapeutic radiological services require a copay and at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance. While some services are covered, specific programs including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered in practice and require copayments ranging from $25 to $50.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Simple (HMO-POS) with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 to 20 and days 51 to 100, a $218 daily copay for days 21 to 50, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Wellcare Simple (HMO-POS) provides partial coverage for other services, offering over-the-counter (OTC) items and a meal benefit for chronic illness with no copay and no coinsurance. Acupuncture is not covered under this plan, and the covered meal benefit requires a referral.
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