A non-government entity
Wellcare Simple Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Value (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 Value (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Simple Value (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in OR. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Simple Value (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 Value (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 Value (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 $6600.00 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:
Sign up for Wellcare Simple Value (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple Value (HMO-POS) plan has a $420 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs and specialty tier drugs, there is no copay. For standard generic drugs, you pay 25% coinsurance. For preferred brand drugs, you pay 42% coinsurance at a preferred pharmacy and 43% coinsurance at a standard pharmacy. For non-preferred drugs, you pay 28% coinsurance.
Additional Benefits
The Wellcare Simple Value (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services like primary care and preventive services often have no copay. The plan also covers hearing, vision, and dental services, with specific copays for exams and eyewear. Other covered services include ambulance, emergency, and home health services, with copays or coinsurance depending on the service. The plan provides coverage for home infusion, dialysis, and medical equipment, with varying coinsurance requirements. Additionally, the plan covers some outpatient services like substance abuse and partial hospitalization, and also offers an OTC benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $673 for days 1-4 and no copay for days 5-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a copay of $458 for days 1-5 and no copay for days 6-90. Additional days, upgrades, and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Wellcare Simple Value (HMO-POS) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $500, observation services with a copay between $125 and $500, and ambulatory surgical center services with a $300 copay. The plan also covers outpatient substance abuse services, individual sessions for outpatient substance abuse with a $25 copay, and group sessions for outpatient substance abuse with a $25 copay. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple Value (HMO-POS) plan, but requires prior authorization. This benefit has a copay of $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple Value (HMO-POS) plan. Medicare-covered ground and air ambulance services have a $310 copay, with no coinsurance, while 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 Simple Value (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Value (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and specialist visits with a $25 copay. Occupational therapy and physical therapy services each have a $45 copay. Mental health and psychiatric individual and group sessions each have a $25 copay, and other health care professionals have a copay between $0 and $25. Additional telehealth benefits have a copay between $0 and $55, and opioid treatment program services have a $25 copay.
Preventive Services See details
The Wellcare Simple Value (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Alternative Therapies, and Remote Access Technologies, all with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
The Wellcare Simple Value (HMO-POS) plan covers hearing exams with a $25 copay, and also covers routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per year, but specific types of prescription hearing aids such as inner ear, outer ear, and over-the-ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Wellcare Simple Value (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams have a copay of $0-$25, and routine eye exams have a $0 copay. Eyewear has a $0 copay, with a combined maximum plan benefit coverage of $100 per year.
Dental Services See details
The Wellcare Simple Value (HMO-POS) plan covers Medicare Dental Services with a $25 copay, and Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services with no copay. Orthodontic Services are also covered. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. The plan covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple Value (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and requires prior authorization, and Prosthetic Devices and Medical Supplies, which are covered with a 20% coinsurance. Diabetic Equipment, including Diabetic Supplies (no copay) and Diabetic Therapeutic Shoes/Inserts (20% coinsurance) are covered, but require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with coinsurance, Diagnostic Procedures/Tests with at most 20% coinsurance and no copay, lab services with no copay, diagnostic radiological services with a copay of at most $500, therapeutic radiological services with at most 20% coinsurance, and outpatient X-ray services with a $75 copay. Prior authorization is required for diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple Value (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 Simple Value (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) services are covered by the Wellcare Simple Value (HMO-POS) plan, but require prior authorization. For days 1-20 and days 51-100, there is no copay, but there is a $214 copay for days 21-50.
Other Services See details
Other Services under the Wellcare Simple Value (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $35 every three months. Acupuncture, Meal Benefit, 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 are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved