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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 OR. 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 $7500.00 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 features an annual prescription drug deductible of $615. Beneficiaries can save significantly on generic medications, as Tier 1 preferred generics and Tier 2 generics have no copay when filled at a preferred pharmacy or through preferred mail order. Additionally, Tier 6 select care drugs are highly accessible with no copay across all standard and preferred pharmacies and mail-order options. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 32% coinsurance. Standard pharmacies and standard mail-order services are also available for Tier 1 and Tier 2 generic drugs, with copayments ranging from $5 to $30 depending on the tier and supply duration.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive coverage for everyday healthcare needs, featuring no copay and no coinsurance for primary care visits, preventive services, routine vision exams, and preventive dental care. Specialist visits require a $30 copay, while physical, occupational, and mental health therapies are available for a $25 copay with no coinsurance. Additionally, members can access routine hearing exams and up to $500 per ear annually for prescription hearing aids with no copay or coinsurance. For major medical services, inpatient hospital stays require a $600 copay per day for the first four days and no copay for days five through 90, with no coinsurance. Outpatient hospital services range from no copay up to $500, emergency care has a $115 copay, and home health services are covered with no copay. While laboratory and diagnostic tests feature no copay, a 20% coinsurance applies to dialysis services, durable medical equipment, and therapeutic radiological services.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute stays require a $600 copay for days 1 to 4 and no copay for days 5 to 90, while psychiatric stays require a $400 copay for days 1 to 5 and no copay for days 6 to 90, with additional days, upgrades, and non-Medicare-covered stays not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services with no coinsurance, featuring a copay of no copay to $500 for outpatient hospital services and $115 to $500 per stay for observation services. Ambulatory surgical center services require a $250 copay, outpatient substance abuse sessions have a $25 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance services under Wellcare Simple (HMO-POS) require prior authorization and have a $310 copay with no coinsurance for both ground and air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $40 copay, with no coinsurance for either service and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 lifetime maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Physical, occupational, and mental health therapies have a $25 copay and no coinsurance, but podiatry services are not covered and chiropractic benefits are only partially covered.
Preventive Services See details
Wellcare Simple (HMO-POS) covers preventive services, including annual physical exams and health screenings with no copay and no coinsurance, though kidney disease education requires no copay and a 20% coinsurance. Additional preventive benefits are partially covered, offering memory fitness, remote access, and alternative therapies with no copay and no coinsurance, while excluding health education, weight management, and in-home safety assessments.
Hearing Services See details
Wellcare Simple (HMO-POS) covers hearing services, offering Medicare-covered exams for a $30 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered up to $500 per ear yearly with no copay or coinsurance, but OTC hearing aids and inner, outer, and over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) partially covers vision services with no coinsurance, offering one routine eye exam annually with no copay, while other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a $100 combined maximum per year.
Dental Services See details
Dental services are partially covered by Wellcare Simple (HMO-POS), featuring Medicare-covered dental care for a $30 copay and no coinsurance, and preventive services like exams and cleanings for no copay and no coinsurance. Comprehensive coverage is limited to adjunctive general services with no copay and no coinsurance, while restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple (HMO-POS) with no copay, and Medicare Part B insulin is available for a $35 copay with no coinsurance. Other covered Medicare Part B chemotherapy, radiation, and miscellaneous drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Simple (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copays for these items. A 20% coinsurance applies to DME, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts, with prior authorization required for most services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO-POS) subject to prior authorization, offering no copays for lab services, diagnostic tests, and diagnostic radiological services. A 20% coinsurance applies to diagnostic tests and therapeutic radiological services, while outpatient X-rays require a $50 copay and coinsurance.
Home Health Services See details
Wellcare Simple (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Simple (HMO-POS) with no coinsurance, though flat copays apply depending on the specific service. You will pay a $30 copay for standard cardiac rehabilitation, $40 for intensive cardiac rehabilitation, $25 for pulmonary rehabilitation, and $20 for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellcare Simple (HMO-POS) with no coinsurance, featuring no copay for days 1 to 20 and days 61 to 100, and a $218 copay per day for days 21 to 60. Prior authorization is required, and while a 3-day prior hospital stay is not required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) covers acupuncture with no copay and no coinsurance for up to 24 treatments per year with prior authorization, though other services like over-the-counter (OTC) items and meal benefits are not covered.
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