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Wellcare Fidelis Patriot Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Fidelis Patriot 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 Patriot Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Fidelis Patriot Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2026 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 Patriot Simple (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Fidelis Patriot 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 Patriot 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 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
Prescription drugs are not covered by Wellcare Fidelis Patriot Simple (HMO-POS).
Additional Benefits
The Wellcare Fidelis Patriot Simple (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care, mental health visits, and home health services. For inpatient hospital stays, members pay a $300 daily copay for days one through five and no copay for days six through ninety, while emergency room visits require a $115 copay. Specialist visits and physical therapy are highly affordable with a $20 copay and no coinsurance. This plan also features robust supplemental benefits, including no copay for preventive dental, routine vision, and annual hearing exams, along with a $3,000 annual dental limit and a $750 annual per-ear hearing aid allowance. Vision benefits include a $200 annual allowance for contacts and eyeglasses with no copay. Additionally, members benefit from no copay on diagnostic tests, acupuncture, and over-the-counter items, though durable medical equipment and dialysis require a twenty percent coinsurance.
Inpatient Hospital See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1 to 5 (no copay for days 6 to 90) for acute stays and a $350 copay per stay for psychiatric care. This benefit is partially covered, as prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from no copay to $450, alongside observation services with copays of $115 to $450 per stay. Ambulatory surgical center services require a $50 copay and no coinsurance, while outpatient substance abuse and blood services are covered with no copays or coinsurance.
Partial Hospitalization See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers Medicare-approved ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Non-emergency transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $25 copay, both with no coinsurance and copays waived if admitted within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers primary care, mental health, and psychiatric services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $20 copay and no coinsurance. Chiropractic care is partially covered with a $15 copay and no coinsurance, excluding other chiropractic services, whereas telehealth services have a $0 to $25 copay with no coinsurance, and podiatry services are not covered.
Preventive Services See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers preventive services, including annual physical exams, fitness benefits, alternative therapies, remote access, and routine screenings, with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance and no copay. Additional preventive benefits are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Wellcare Fidelis Patriot Simple (HMO-POS), offering Medicare-covered exams for a $20 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Fidelis Patriot Simple (HMO-POS) with no coinsurance, though other eye exam services are not covered. Routine yearly eye exams and eyewear—including contacts and eyeglasses up to a $200 annual limit—feature no copay, while other covered eye exams may require a copay up to $20.
Dental Services See details
Wellcare Fidelis Patriot Simple (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $20 copay and no coinsurance. Preventive and most comprehensive dental services have no copay and no coinsurance up to a $3,000 annual limit, though implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Fidelis Patriot Simple (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Fidelis Patriot Simple (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 require a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers diagnostic procedures, tests, and lab services with no copay and no coinsurance, subject to prior authorization. Covered radiological services also require prior authorization and include outpatient X-rays for a $50 copay plus coinsurance, therapeutic services with a copay and a minimum 20% coinsurance, and diagnostic radiology starting at no copay.
Home Health Services See details
Home health services are covered under the Wellcare Fidelis Patriot Simple (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers cardiac rehabilitation services with no coinsurance, but some services are not covered, including standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease. These non-covered services instead require copayments ranging from $20 to $40 per visit.
Skilled Nursing Facility (SNF) See details
Wellcare Fidelis Patriot Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 71 to 100, and a $218 daily copay for days 21 to 70. Prior authorization is required, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Wellcare Fidelis Patriot Simple (HMO-POS) partially covers other services, offering acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance. However, other general supplemental services and dual-eligible SNP benefits are not covered.
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