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 2025, 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 2025.
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.
Below are a few key facts and commonly-asked questions about Wellcare Simple (HMO-POS).
The cost of a Medicare Advantage Plan is made up of four main parts.
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 $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 $4600.00 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.
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The Wellcare Simple (HMO-POS) plan has a $420 deductible for prescription drugs. After the deductible, you will pay the following costs for drugs. For preferred generic drugs, you will have no copay at a preferred pharmacy or preferred mail order, and a $10 copay at a standard pharmacy or standard mail order. For standard generic drugs, you will pay 25% coinsurance at any pharmacy or mail order. For preferred brand drugs, you will pay 44% coinsurance at a preferred pharmacy or preferred mail order, and 45% coinsurance at a standard pharmacy. Non-preferred drugs have 28% coinsurance, and specialty tier drugs have no copay.
The Wellcare Simple (HMO-POS) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services, and emergency care. You'll find no copays for primary care visits, preventive services, and many dental services. This plan also provides coverage for hearing and vision services, with copays for exams and allowances for eyewear and hearing aids. Additionally, the plan covers ambulance services, transportation to plan-approved health-related locations, and offers benefits for home health services and skilled nursing facilities.
Inpatient Hospital benefits are covered by the Wellcare Simple (HMO-POS) plan, with a copay of $350 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric has a copay of $300 for days 1-7 and no copay for days 8-90. Additional days, and non-Medicare covered stays are not covered.
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $280, observation services with a copay between $125 and $280, and ambulatory surgical center services with a $175 copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization is covered by the Wellcare Simple (HMO-POS) plan, with a $105 copay and prior authorization required.
Ambulance and Transportation Services are covered by the Wellcare Simple (HMO-POS) plan. Ground and air ambulance services have a $300 copay, and transportation services have no copay. Transportation services to any health-related location are not covered. Transportation services to a plan-approved health-related location are limited to 24 one-way trips per year and can be via rideshare services, bus/subway, or medical transport.
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered benefits under the Wellcare Simple (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services has a $45 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
The Wellcare Simple (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $30 copay. The plan also covers physician specialist services with a $25 copay, and mental health specialty services with a copay of $40 for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a copay between $0 and $45. Opioid Treatment Program Services have a copay of $25. Podiatry services are not covered.
The Wellcare Simple (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Other preventive services are covered, and specific services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Kidney Disease Education Services has a 20% coinsurance.
Wellcare Simple (HMO-POS) covers hearing exams with a $25 copay, and also covers routine hearing exams and fitting/evaluation for hearing aids with no copay, limited to one visit per year. Prescription hearing aids are covered, with a maximum benefit of $1000 per year, and prescription hearing aids (all types) are covered with no copay, limited to two visits per year. Inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
The Wellcare Simple (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$25, and eyewear with no copay. Eyewear coverage includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $300 per year.
Dental services include coverage for Medicare Dental Services with a $25 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Orthodontic services are covered up to a maximum of $3000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services are covered, but require prior authorization. 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 are covered by the Wellcare Simple (HMO-POS) plan. The coinsurance for dialysis services is 20%.
The Wellcare Simple (HMO-POS) plan covers Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies and Medical Supplies are covered with 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services include coverage for all diagnostic services and lab services with a copay of up to $100, as well as outpatient X-ray services for a $45 copay. Therapeutic Radiological Services have a coinsurance of at least 20%, while Diagnostic Radiological Services have a copay of up to $280.
Home Health Services are covered by the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services are covered by the Wellcare Simple (HMO-POS) plan. However, 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 are not covered.
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple (HMO-POS) plan, but require prior authorization. For days 1-20 and 51-100, there is no copay, but for days 21-50, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services includes coverage for over-the-counter (OTC) items and meal benefits, with no copay for either. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many additional services are not covered.
SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
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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.
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