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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 2026 to people living in Select Counties in WI. This plan received an overall rating of 3.5 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 $5300.00 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. For Tier 1 preferred generics and Tier 2 generics, there is no copay when filled through a preferred pharmacy or preferred mail order. Additionally, Tier 6 select care drugs require no copay at either preferred or standard pharmacies and mail order services. For Tier 3 preferred brand drugs and Tier 5 specialty drugs, you will pay a 25% coinsurance. Tier 4 non-preferred drugs require a 35% coinsurance across all pharmacy and mail order channels. Standard pharmacies and standard mail order services carry copays ranging from $5 to $30 for Tier 1 and Tier 2 medications depending on the supply duration.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers comprehensive medical coverage with predictable costs, featuring no copay for primary care visits and a $30 copay for specialists. For inpatient hospital stays, members pay a $325 copay for days one through six and no copay for days seven through 90, with no coinsurance. Emergency care is available with a $130 copay, while urgent care visits require a $30 copay. This plan also provides robust supplemental benefits, including no copay for routine eye exams, eyewear up to $300, and preventive and comprehensive dental care up to a $2,000 annual limit. Routine hearing exams have no copay, and prescription hearing aids are covered up to $1,500 per ear annually. Additionally, skilled nursing facility stays feature no copay for days one through 20, and home health services are covered with no copay.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, featuring a $325 copay for days 1 through 6 and no copay for days 7 through 90 per stay. Prior authorization is required for these services, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Simple (HMO-POS) with no coinsurance, featuring copays ranging from $0 to $275 for outpatient hospital services and $130 to $275 for observation services. Ambulatory surgical center visits require a $250 copay, outpatient substance abuse sessions carry a $25 copay, and outpatient blood services are provided with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Simple (HMO-POS) plan with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance, requiring prior authorization. For transportation benefits, some services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $30 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical and occupational therapies require a $40 copay and no coinsurance, while podiatry is not covered, and chiropractic benefits cover some services but exclude routine and other chiropractic care.
Preventive Services See details
Preventive services are partially covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance for annual physicals, fitness benefits, and select screenings, though kidney disease education has no copay and 20% coinsurance. Sub-services not covered under this benefit include health education, in-home safety assessments, medical nutrition therapy, weight management, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Wellcare Simple (HMO-POS) covers hearing exams with a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,500 per ear annually, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) offers partially covered vision services with no coinsurance and no deductibles, though prior authorization is required. Routine annual eye exams and eyewear (up to a $300 yearly limit) have no copay, while other eye exams have a copay up to $30 and other eye exam services are not covered.
Dental Services See details
Wellcare Simple (HMO-POS) partially covers dental services, offering Medicare-covered dental services with a $30 copay and no coinsurance, as well as preventive and comprehensive dental services with no copay and no coinsurance up to a $2,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and prior authorization is required for most services.
Home Infusion bundled Services See details
Wellcare 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 and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
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
Wellcare Simple (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies from specified manufacturers are covered with no copay, while diabetic therapeutic shoes and inserts have no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services with prior authorization, featuring no copay or coinsurance for lab services and a $0 to $35 copay with no coinsurance for diagnostic tests. Radiological services range from a $0 copay for diagnostic imaging to a $50 copay for X-rays, with therapeutic radiology requiring a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Under this plan, there is no copay for days 1 through 20 and days 51 through 100, a $218 daily copay for days 21 through 50, and additional days beyond the Medicare-covered limit are not covered.
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, though a referral is required for meals. Acupuncture and other additional services are not covered under this plan.
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