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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 2025, 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 OR. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $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 $6000.00 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) plan has a $420 deductible for prescription drugs. In the initial coverage phase, you'll pay different amounts depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred and mail-order pharmacies, while standard generic drugs have 25% coinsurance. The plan also includes a catastrophic coverage phase where you pay nothing for covered drugs after your yearly out-of-pocket drug costs reach $2000. If you qualify for the low-income subsidy (LIS), you may have a reduced premium. Check the plan's formulary for specific drug coverage details.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, and various outpatient services with copays or coinsurance. The plan also provides coverage for primary care, preventive services, and mental health services, often with no copay. Additional benefits include hearing, vision, and dental services with varying cost-sharing, as well as coverage for medical equipment and home health services. The plan also covers ambulance services with a copay, and offers coverage for emergency services, along with coverage for OTC items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Wellcare Simple (HMO-POS) plan. For Inpatient Hospital-Acute, you will pay a $500 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $400 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
The Wellcare Simple (HMO-POS) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $400, observation services with a copay between $125 and $400, and ambulatory surgical center services with a $250 copay. The plan also covers outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
The Wellcare Simple (HMO-POS) plan covers ambulance services with a $310 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
The Wellcare Simple (HMO-POS) plan covers emergency services with a $125 copay and no coinsurance, and urgently needed services with a $55 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage are covered with a $125 copay and no coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple (HMO-POS) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy, physical therapy, and speech-language pathology services have a $25 copay, while physician specialist services have a $25 copay, and mental health and psychiatric services have a $25 copay for individual and group sessions.
Preventive Services See details
The Wellcare Simple (HMO-POS) plan covers preventive services, including an annual physical exam with no copay, and other preventive services with varying copays. Alternative Therapies, Fitness Benefit, and Remote Access Technologies have a $0 copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per year, while inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) covers vision services, including eye exams and eyewear. Routine eye exams have no copay, and other eye exams have a copay between $0 and $25, while eyewear has no copay and a combined maximum benefit of $100 per year.
Dental Services See details
Dental Services are covered, with specific services having different cost-sharing. Medicare Dental Services have a $25 copay. Oral exams and dental x-rays have no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery have 20% coinsurance. Orthodontic services are covered up to a maximum of $1500 per year. Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Wellcare Simple (HMO-POS) plan covers medical equipment, including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic equipment is covered, including diabetic supplies with no copay, and diabetic therapeutic shoes/inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Simple (HMO-POS) plan. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $400.00, and Outpatient X-Ray Services have a copay of $25.00. Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Simple (HMO-POS) plan, though the plan does not specify the cost sharing details. However, the plan specifies that Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but require prior authorization. For days 1-20 and 51-100, there is no copay, while days 21-50 have a copay of $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Simple (HMO-POS) plan covers acupuncture with no copay, but requires prior authorization and is limited to 24 treatments per year. Over-the-counter (OTC) items are covered with no copay, with a maximum benefit of $30 every three months, and includes nicotine replacement therapy and Naloxone coverage. Other services, including meal benefits, are not covered.
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