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Wellcare Giveback (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Giveback (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 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 Giveback (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 Giveback (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 Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $40.00. You must continue to pay paying your reduced 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 $9250.00 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 Giveback (HMO-POS) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will enjoy no copay when filling your prescriptions through a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 select care drugs are highly accessible with no copay across all preferred and standard pharmacy 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 both require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance. Standard pharmacies and standard mail-order services are also available for generic prescriptions, with copays starting as low as $5.
Additional Benefits
The Wellcare Giveback (HMO-POS) plan offers affordable essential medical coverage featuring no copay and no coinsurance for primary care doctor visits, routine physicals, and home health services. For specialist visits, Medicare-covered dental care, and hearing exams, patients pay a predictable $25 copay with no coinsurance. Inpatient hospital stays require a daily copay for the first four days, followed by no copay for days 5 through 90. Emergency room visits require a $115 copay and urgent care visits require a $40 copay, with no coinsurance for either service. This plan also covers routine eye exams, annual eyewear up to a $100 limit, and routine hearing exams with no copay and no coinsurance. Additionally, medical equipment and dialysis services are covered with no copay and a 20 percent coinsurance.
Inpatient Hospital See details
Wellcare Giveback (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays require a $570 daily copay for days 1 through 4 and no copay for days 5 through 90, while psychiatric stays require a $450 daily copay for days 1 through 4 and no copay for days 5 through 90, with additional days, upgrades, and non-Medicare stays not covered.
Outpatient Services See details
Wellcare Giveback (HMO-POS) covers outpatient hospital services with a copay ranging from $0 to $500 and 30% coinsurance, and observation services with a $115 copay and 30% coinsurance. Ambulatory surgical center services require a $250 copay with no coinsurance, outpatient substance abuse sessions have a $25 copay with no coinsurance, and outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellcare Giveback (HMO-POS) with a $105.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Giveback (HMO-POS) covers Medicare-covered ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Giveback (HMO-POS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, both of which count toward the plan-level deductible and are waived if admitted 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, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback (HMO-POS) features primary care doctor visits with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $25 copay and no coinsurance. Some chiropractic services are covered, though routine and other chiropractic services are not covered, and podiatry services are not covered by the plan. Telehealth options are also available with a copay ranging from $0 to $40 and no coinsurance.
Preventive Services See details
Wellcare Giveback (HMO-POS) offers partially covered preventive services, featuring annual physical exams, alternative therapies, memory fitness, remote access, and screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. Non-covered sub-services include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Giveback (HMO-POS) partially covers hearing services, featuring a $25 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Giveback (HMO-POS) vision services are partially covered, as other eye exam services are not covered. Covered benefits, including one annual routine eye exam and eyewear up to a $100 yearly limit, require prior authorization but feature no copay, no coinsurance, and no deductible.
Dental Services See details
Wellcare Giveback (HMO-POS) provides partially covered dental services, featuring Medicare-covered dental care for a $25 copay and no coinsurance, and preventive and adjunctive services with no copay and no coinsurance. Restorative services, endodontics, periodontics, prosthodontics, implants, oral and maxillofacial surgery, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Wellcare Giveback (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Giveback (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Giveback (HMO-POS) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Wellcare Giveback (HMO-POS) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $30 copay for procedures. Radiological services require prior authorization, with outpatient X-rays costing a $50 copay plus coinsurance, diagnostic radiology starting at no copay, and therapeutic radiology requiring a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Wellcare Giveback (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Giveback (HMO-POS) offers cardiac rehabilitation services with no coinsurance, but only some services are covered. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Giveback (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 71 to 100, a $218 daily copay for days 21 to 70, and additional days beyond the Medicare-covered limit of 100 days are not covered.
Other Services See details
Wellcare Giveback (HMO-POS) partially covers other services, offering a chronic illness meal benefit with no copay and no coinsurance, though a referral is required. Supplemental services such as acupuncture and over-the-counter (OTC) items are not covered.
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