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Wellcare Fidelis Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Fidelis 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 Fidelis Assist (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Fidelis Assist (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in NY. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Fidelis 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 Fidelis 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 Fidelis Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.40. 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 $460.00 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 $6900.00 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 Fidelis Assist (HMO-POS) plan has a $460 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For preferred generic drugs, you'll pay a $19 copay at a preferred pharmacy, and for preferred brand drugs, you'll pay a $100 copay. The plan has a specialty tier with no copay.
Additional Benefits
The Wellcare Fidelis Assist (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays or coinsurance depending on the service. Emergency services and ambulance services have copays, while primary care visits have no copay. Preventive services, including an annual physical, and many vision and dental services are covered with no copay. Hearing exams have a copay, and hearing aids are covered up to a certain amount. The plan also covers home health services, and many other services with copays or coinsurance, and some services with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For acute care, you pay a $450 copay for days 1-5, and no copay for days 6-90; you also have 10 additional days at no copay. Inpatient Hospital Psychiatric care has a $375 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 20% coinsurance and a copay between $0 and $400, Observation Services with a 20% coinsurance and a $110 copay, and Ambulatory Surgical Center (ASC) Services with a $200 copay. The plan also covers Outpatient Substance Abuse Services with a $25 copay for both individual and group sessions, as well as Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Fidelis Assist (HMO-POS) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $310 copay for both Ground and Air Ambulance Services; there is no coinsurance. 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 $110, $30, and $110 respectively, and no coinsurance. Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The Wellcare Fidelis Assist (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services, physical therapy, and speech-language pathology services with a $25 copay, and additional telehealth benefits with a copay between $0 and $30. Mental health and psychiatric services, and opioid treatment program services are also covered, with a copay of $25. Podiatry services are not covered.
Preventive Services See details
The Wellcare Fidelis Assist (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services are covered, including glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $350 per ear per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision Services include coverage for eye exams, routine eye exams, and eyewear. Eye exams have a copay between $0 and $25, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $200 per year.
Dental Services See details
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, and oral and maxillofacial surgery, all with no copay. Orthodontic Services are covered up to a $2,000 annual maximum. Prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered under the Wellcare Fidelis Assist (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 Fidelis Assist (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) requiring a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment are also covered, with Medicare-covered Prosthetic Devices and Medical Supplies requiring a 20% coinsurance, and Medicare-covered Diabetic Therapeutic Shoes or Inserts requiring a 20% coinsurance and Medicare-covered Diabetic Supplies having no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $20, and lab services with no copay. Radiological services are covered, including diagnostic radiological services with a copay of at most $400, therapeutic radiological services with coinsurance of at least 20%, and outpatient X-ray services with a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Fidelis Assist (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 Fidelis Assist (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 Fidelis Assist (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60.
Other Services See details
The Wellcare Fidelis Assist (HMO-POS) plan covers acupuncture with no copay, but requires prior authorization and is limited to 12 treatments per year. Over-the-counter items are covered with no copay, including nicotine replacement therapy and naloxone, with a maximum benefit of $110 every three months. The plan also covers a meal benefit with no copay, for chronic illnesses, with a doctor referral required. Other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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