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Wellcare Fidelis Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Fidelis 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 Fidelis Simple (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Fidelis Simple (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 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 Fidelis 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 Fidelis 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 $8300.00 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 Simple (HMO-POS) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay no copay at preferred pharmacies and no copay at preferred mail order. For standard generic drugs, the coinsurance is 25% at all pharmacies. For specialty drugs, there is no copay.
Additional Benefits
The Wellcare Fidelis Simple (HMO-POS) plan offers a wide range of benefits with varying cost-sharing. This plan provides coverage for inpatient hospital stays with copays, outpatient services with copays and coinsurance, and emergency services with copays. Primary care visits are covered with no copay, while specialist visits and therapies have copays. Preventive services are largely covered with no copay, including vision and dental services. Additional benefits include home health services with no copay, hearing exams with a copay, and coverage for medical equipment with coinsurance. The plan also covers ambulance services and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits for the Wellcare Fidelis Simple (HMO-POS) plan include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For Inpatient Hospital-Acute, you'll pay a $475 copay for days 1-5 and no copay for days 6-90, while Inpatient Hospital Psychiatric services have a $400 copay for days 1-5 and no copay for days 6-90. 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 include coverage for Outpatient Hospital Services with a 30% coinsurance and a copay between $0 and $500, Observation Services with a 30% coinsurance and a $110 copay, Ambulatory Surgical Center (ASC) Services with a $475 copay, and Outpatient Substance Abuse Services with a $35 copay for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Wellcare Fidelis Simple (HMO-POS) plan, but requires prior authorization and has a copay of $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Fidelis Simple (HMO-POS) plan, with no coinsurance for any services. Ground and Air Ambulance Services have a $350 copay, but Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Fidelis Simple (HMO-POS) plan. Emergency Services have a $110 copay and no coinsurance. Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Coverage has a $110 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Under the Wellcare Fidelis Simple (HMO-POS) plan, primary care physician services have no copay, chiropractic services have a $15 copay, and occupational therapy services have a $35 copay. Physician specialist services have a $25 copay, while mental health specialty services, psychiatric services, and opioid treatment program services have a $35 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a copay between $0 and $45.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services, some of which have a copay. Kidney Disease Education Services have 20% coinsurance, and 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, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$25, while eyewear has no copay and a combined maximum of $200 per year.
Dental Services See details
Wellcare Fidelis Simple (HMO-POS) covers dental services, including 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 with no copay. Orthodontic services have a maximum benefit of $1500 per year, while prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Fidelis Simple (HMO-POS) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Fidelis Simple (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The Wellcare Fidelis Simple (HMO-POS) plan covers medical equipment, including durable medical equipment with 20% coinsurance and prosthetic devices with 20% coinsurance. Diabetic supplies have no copay and are covered, while diabetic therapeutic shoes/inserts have 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $50, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $500, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with a $50 copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the Wellcare Fidelis Simple (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Fidelis Simple (HMO-POS) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered with 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 Simple (HMO-POS) plan does not cover acupuncture, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, 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. The plan covers meal benefits with a $0 copay, and a doctor referral is required.
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