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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Fidelis Simple (HMO-POS) is a HMO-POS plan offered by New York Quality Healthcare Corporation available for the 2026 plan year to people living in Select counties in NY. This plan received an overall rating of 3 out of 5 stars in 2026.
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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 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 an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using preferred pharmacies or preferred mail-order services. Additionally, Tier 6 select care drugs are covered with no copay at both preferred and standard pharmacies. For higher-tier medications, costs are based on coinsurance, with Tier 3 preferred brands and Tier 5 specialty drugs requiring 25% coinsurance. Tier 4 non-preferred drugs carry a 39% coinsurance across all pharmacy options. If you choose standard pharmacies or standard mail-order for your generics, copays range from $5 to $30 depending on the tier and supply length.
Additional Benefits
The Wellcare Fidelis Simple (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, including no copay for primary care visits and a $25 copay for specialist visits. Preventive care, annual physicals, and fitness benefits are fully covered with no copay or coinsurance. For emergencies, the plan features a $115 copay for emergency room care and a $40 copay for urgent care visits. This plan also includes valuable supplemental benefits, featuring no copay for preventive dental care, routine annual eye exams, and routine hearing tests. Members also benefit from no copay for home health services, alongside annual allowances of up to $200 for eyewear and $750 per ear for prescription hearing aids. Major medical needs, such as inpatient hospital stays and medical equipment, are covered with daily copayments or a 20% coinsurance.
Inpatient Hospital See details
Wellcare Fidelis Simple (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $600 daily copay for days 1 to 4 of acute stays and a $500 daily copay for days 1 to 4 of psychiatric stays, with no copay for days 5 to 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Fidelis Simple (HMO-POS) covers outpatient hospital services with no copay and a 30% coinsurance, and observation services with a $115 copay per stay and a 30% coinsurance. Ambulatory surgical center services require a $475 copay with no coinsurance, outpatient substance abuse sessions cost a $35 copay with no coinsurance, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Fidelis Simple (HMO-POS) with a $105.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Fidelis Simple (HMO-POS) covers Medicare-approved ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under Wellcare Fidelis Simple (HMO-POS) are covered with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency and urgent care are also covered up to a $50,000 maximum limit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Fidelis Simple (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, and mental health services require a $35 copay and no coinsurance, while telehealth benefits have a $0 to $40 copay and no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Fidelis Simple (HMO-POS) provides preventive services, including annual physicals, fitness benefits, alternative therapies, and screenings, with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Additional preventive benefits are partially covered, as the plan excludes health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing Services covered by Wellcare Fidelis Simple (HMO-POS) include routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $25 copay and no coinsurance. Prescription hearing aids are partially covered up to $750 per ear annually with no copay and no coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services covered by Wellcare Fidelis Simple (HMO-POS) include eye exams with a $0 to $25 copay and no coinsurance, featuring one routine annual exam with no copay, while other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay, no coinsurance, and a $200 annual maximum limit, though prior authorization is required.
Dental Services See details
Wellcare Fidelis Simple (HMO-POS) covers dental services with a $25 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care like exams, cleanings, and x-rays. However, dental benefits are only partially covered, as restorative services, endodontics, periodontics, prosthodontics, implants, maxillofacial prosthetics, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Wellcare Fidelis Simple (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Fidelis Simple (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Fidelis Simple (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copay for covered items. A 20% coinsurance applies to DME, medical supplies, prosthetic devices, and diabetic therapeutic shoes or inserts, and prior authorization is required.
Diagnostic and Radiological Services See details
Wellcare Fidelis Simple (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and diagnostic tests with no coinsurance and a $0 to $50 copay. For radiological services, outpatient X-rays require a $50 copay, therapeutic radiology requires a 20% coinsurance, and diagnostic radiology requires a copay with no coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellcare Fidelis Simple (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Fidelis Simple (HMO-POS) covers some Cardiac Rehabilitation Services with no coinsurance, though standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered and require copayments ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Wellcare Fidelis Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 71 through 100, a $218 copay for days 21 through 70, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are offered by Wellcare Fidelis Simple (HMO-POS), and while some services are covered, acupuncture, over-the-counter (OTC) items, meal benefits, and highly integrated dual-eligible SNP services are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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