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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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Simple (HMO-POS) is a HMO-POS plan offered by Wellcare of Maine, Inc. available for the 2026 plan year to people living in Select counties in ME. 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 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) prescription drug plan features an annual drug deductible of $615. You can enjoy no copay on Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filling prescriptions at a preferred pharmacy or through preferred mail order. If you choose standard pharmacies or standard mail order, these generic tiers require copays ranging from $5 to $30 depending on the supply. For brand-name and specialty medications, costs are determined by coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs carry a 25% coinsurance, while Tier 4 non-preferred drugs require a 35% to 36% coinsurance. These coinsurance rates apply across preferred and standard pharmacy options for both one-month and multi-month supplies.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers affordable medical coverage with no copay for primary care physician visits and a $25 copay for specialist visits. Inpatient hospital stays require a daily copay for the first four days followed by no copay for days five through 90, while emergency room visits carry a $115 copay. Outpatient care is also accessible, featuring a $250 copay for ambulatory surgical center services and no copay for outpatient blood services. Additional benefits include routine dental, vision, and hearing exams with no copay, as well as allowances for prescription hearing aids and eyewear. Preventive services and home health care are also covered with no copay or coinsurance to help you stay healthy at home. For medical equipment and dialysis services, members will pay a 20% coinsurance, while skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays require a $550 copay per day for days 1 through 4 (no copay for days 5 through 90) and psychiatric stays require a $450 copay per day for days 1 through 4 (no copay for days 5 through 90), while upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient services, featuring outpatient hospital care with 30% coinsurance and copays ranging from no copay up to $500. Ambulatory surgical center services require a $250 copay with no coinsurance, outpatient substance abuse services have a $25 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Simple (HMO-POS) plan with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers Medicare-covered ground and air ambulance services with a $300 copayment and no coinsurance, though prior authorization is required. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Wellcare Simple (HMO-POS) with a $115 copay and no coinsurance, while urgently needed services have a $30 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) covers primary care physician visits with no copay and no coinsurance, while specialist visits, therapy, and mental health services require a $25 copay and no coinsurance. Additional telehealth services feature a copay ranging from $0 to $30 with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) provides partially covered preventive services, offering annual physical exams, alternative therapies, memory fitness, remote access technologies, and other screenings with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, but several supplemental benefits such as health education, in-home safety assessments, personal emergency response systems, and nutritional services are not covered.
Hearing Services See details
Wellcare Simple (HMO-POS) hearing services are partially covered, offering Medicare-covered exams for a $25 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) provides partially covered vision services with no coinsurance, offering one routine eye exam per year with no copay, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 combined annual maximum for contact lenses, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Wellcare Simple (HMO-POS) offers partially covered dental services, with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Medicare-covered dental services require a $25 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance up to a $1,000 annual limit.
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 is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 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
Medical equipment is covered under Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are offered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple (HMO-POS), with prior authorization required for most services. Diagnostic tests, lab services, and diagnostic radiological services feature no copay and no coinsurance, while outpatient X-rays require a $50 copay (plus coinsurance) and therapeutic radiology services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, but only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, requiring copayments ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. You will pay no copay for days 1 to 20 and days 71 to 100, and a $218 daily copay for days 21 to 70, though additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers other services, offering a chronic illness meal benefit with no copay and no coinsurance, although a referral is required. Acupuncture, over-the-counter (OTC) items, and other supplemental services are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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