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Wellcare Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Assist (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 Assist (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 Assist (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 Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.80. 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 $580.00 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 Assist (HMO-POS) prescription drug coverage includes an annual drug deductible of $580. For Tier 1 preferred generics and Tier 2 generics, one-month retail copays start as low as $18 and $19, with a three-month supply via preferred mail order available with no copay. Furthermore, Tier 6 select care drugs are fully covered with no copay across all fill options and pharmacy types. Higher-tier medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 34% coinsurance for all supply lengths. Specialty drugs classified under Tier 5 require a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, routine annual physicals, and home health services. For specialist visits and Medicare-covered dental exams, members pay a low $25 copay with no coinsurance. Inpatient hospital stays require no coinsurance, though a daily copay applies for the first seven days of acute and psychiatric admissions before transitioning to no copay for subsequent days. This plan also includes excellent supplemental benefits, providing dental care up to a $3,000 annual limit and routine vision exams with eyewear up to a $400 annual limit, all with no copay. Additionally, members can access routine hearing exams and up to $1,500 per ear annually for prescription hearing aids with no copay. Other valuable perks include no-copay over-the-counter items, chronic illness meal benefits, and up to 24 one-way transportation trips per year to approved health locations.
Inpatient Hospital See details
Wellcare Assist (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $350 copay for days 1 to 7 of acute stays and a $300 copay for days 1 to 7 of psychiatric stays, followed by no copay for days 8 to 90. Additional days, upgrades, and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
Wellcare Assist (HMO-POS) covers outpatient services with no coinsurance, featuring a copay of $0 to $275 for outpatient hospital services and $130 to $275 per stay for observation services. Ambulatory surgical center services require a $125 copay, outpatient substance abuse sessions have a $40 copay, and outpatient blood services are covered with no copay and no deductible.
Partial Hospitalization See details
Wellcare Assist (HMO-POS) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellcare Assist (HMO-POS) covers ground and air ambulance services with a $270 copay and no coinsurance per trip. The plan also partially covers transportation, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to non-approved health-related locations is not covered.
Emergency Services See details
Wellcare Assist (HMO-POS) covers emergency services with a $130 copay and no coinsurance, while urgently needed services are covered with no copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO-POS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with copays ranging from $30 to $40 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Assist (HMO-POS) features partially covered preventive services with no copay and no coinsurance for annual physicals, fitness benefits, alternative therapies, and screenings, while kidney disease education has no copay and a 20% coinsurance. Excluded from coverage are health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services under Wellcare Assist (HMO-POS) include 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 partially covered up to $1,500 per ear annually with no copay and no coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Wellcare Assist (HMO-POS) vision services are partially covered with no deductibles and no coinsurance. Routine eye exams have no copay (limited to one per year) and eyewear is covered with no copay up to a $400 annual limit, while other eye exam services are not covered.
Dental Services See details
Wellcare Assist (HMO-POS) partially covers dental services, offering Medicare-covered dental with a $25 copay and no coinsurance, and preventive and most comprehensive services with no copay and no coinsurance up to a $3,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Assist (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs are covered with no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Wellcare Assist (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist (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 are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Assist (HMO-POS) covers diagnostic and radiological services with prior authorization, featuring no copay for lab services and a $0 to $50 copay with no coinsurance for diagnostic tests. Diagnostic radiological services have no copay, outpatient X-rays require a $25 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Wellcare Assist (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Assist (HMO-POS) with no coinsurance, although some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. These uncovered services require copayments of $40 for standard cardiac, $50 for intensive cardiac, $35 for pulmonary, and $25 for SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Wellcare Assist (HMO-POS) with no coinsurance, though additional days beyond the standard Medicare-covered 100 days are not covered. Covered stays require prior authorization but no prior three-day hospital stay, featuring no copay for days 1 to 20 and 51 to 100, and a $218 daily copay for days 21 to 50.
Other Services See details
Other services are partially covered under Wellcare Assist (HMO-POS), featuring over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. A referral is required to receive the meal benefit, and both covered services have no maximum coverage limit.
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