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Wellcare Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 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 Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in KS. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare 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 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 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 $615.00 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 Simple (HMO-POS) Medicare prescription drug plan features an annual drug deductible of $615. You will pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when utilizing preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail-order options, these generic tiers require copays ranging from $5 to $30 depending on the drug tier and supply fill. For brand-name and specialty medications, costs are structured as a percentage of the drug cost rather than a flat copay. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 36% coinsurance across all pharmacy types. This coverage structure ensures significant savings on everyday generic medications while providing clear cost-sharing for specialty prescriptions.
Additional Benefits
Wellcare Simple (HMO-POS) offers affordable healthcare coverage featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits, patients pay a $25 copay with no coinsurance, while emergency room visits require a $130 copay. Inpatient hospital stays feature no coinsurance, with acute care costing a $350 daily copay for the first eight days and no copay for days 9 through 90. The plan also includes key supplemental benefits, including routine dental, vision, and hearing services with no copay or coinsurance. Prescription hearing aids are covered up to $1,000 per ear annually with no copay, and diagnostic lab services are also available with no copay. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, you pay a $350 daily copay for days 1 through 8 and no copay for days 9 through 90, while psychiatric care costs a $290 daily copay for days 1 through 8 and no copay for days 9 through 90, with additional days, upgrades, and non-Medicare-covered stays not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $280, while observation services require a $130 to $280 copay per stay with no coinsurance. Ambulatory surgical center services have a $250 copay, outpatient substance abuse sessions cost a $40 copay, and outpatient blood services have no copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple (HMO-POS) with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency services are partially covered up to a $50,000 limit with a $130 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) provides primary care physician visits with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Other covered services, including physical therapy, mental health, and podiatry, carry copays ranging from $0 to $40 with no coinsurance, while chiropractic benefits are only partially covered because other chiropractic services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) covers preventive services, offering annual physical exams, fitness benefits, alternative therapies, remote access, and other screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. 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 benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, safety modifications, and counseling.
Hearing Services See details
Wellcare Simple (HMO-POS) offers partially covered hearing services with no deductibles, featuring a $25 copay and no coinsurance for Medicare-covered exams, plus no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Wellcare Simple (HMO-POS), offering routine eye exams and eyewear with no coinsurance and no copay, though other eye exam services are not covered. Prior authorization is required, and the plan features a $200 annual maximum for eyewear including contact lenses, eyeglasses, and upgrades.
Dental Services See details
Wellcare Simple (HMO-POS) dental services are partially covered, offering Medicare-covered dental services for a $25 copay and no coinsurance, and preventive and other covered services with no copay and no coinsurance up to a $1,000 annual limit. Sub-services that are not covered under this plan include removable prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Wellcare Simple (HMO-POS) with no copay, requiring prior authorization and step therapy. Covered Medicare Part B insulin drugs have a $35 copay and 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 Simple (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO-POS), with no copay and no coinsurance for lab services, diagnostic tests, and diagnostic radiology. Outpatient X-rays require a $25 copay plus coinsurance, while therapeutic radiological services require a 20% coinsurance plus a copay, with prior authorization required for all services.
Home Health Services See details
Home health services are covered under Wellcare Simple (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) provides cardiac rehabilitation benefits with no coinsurance, but only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, carrying copays of $40, $50, $35, and $25 respectively.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) partially covers Skilled Nursing Facility (SNF) care with no coinsurance, though additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and 41 to 100, while days 21 to 40 require a $218 daily copay, and prior authorization is required.
Other Services See details
Wellcare Simple (HMO-POS) partially covers Other Services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this benefit, and a referral is required for the meal benefit.
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