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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 Statewide in AR. This plan received an overall rating of 3.5 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 $4800.00 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. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For preferred generic drugs, you pay no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. For specialty tier drugs, you pay no copay at any pharmacy.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services range from no copay to $280. Emergency services, primary care, and preventive services, such as an annual physical, often have no copay or low copays, with some specialist visits costing $20. The plan also covers hearing, vision, and dental services with no copays for eye exams and routine hearing exams. Dental services and durable medical equipment have coinsurance, while other services like home health and some home infusion drugs have no copay. The plan also provides benefits such as OTC items and a meal benefit with no copay, and Skilled Nursing Facility (SNF) services with no copay for some days.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Inpatient Hospital-Acute has a copay of $350 for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric has a copay of $325 for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute have no copay for days 91-120. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $280, observation services with a copay between $125 and $280, and ambulatory surgical center services with a $250 copay. The plan also covers outpatient substance abuse services with a copay of $40 for both individual and group sessions, as well as 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. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple (HMO-POS) plan, including both ground and air ambulance services. Ground and air ambulance services have a copay of $275, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare Simple (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage each have a $125 copay, while Urgently Needed Services has a $40 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple (HMO-POS) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $20 copay, Physician Specialist Services with a $20 copay, Mental Health Specialty Services with a $40 copay for individual and group sessions, and Physical Therapy and Speech-Language Pathology Services with a $20 copay. Additional Telehealth Benefits are covered with a copay between $0 and $40, and Opioid Treatment Program Services have a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional services like Fitness Benefit, Remote Access Technologies, In-Home Support Services, and Alternative Therapies may have a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services like Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs have no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $20 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have no copay, and are limited to 2 per year. OTC hearing aids are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) covers vision services, including eye exams and eyewear. Eye exams have a copay of $0-$20, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit of $400 per year.
Dental Services See details
Dental Services are covered, with a $20 copay for Medicare Dental Services. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments have no copay, while restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have a 20% coinsurance. Orthodontic services have a maximum benefit of $2,000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have 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, with a coinsurance of 20%.
Medical Equipment See details
The Wellcare Simple (HMO-POS) plan covers medical equipment with a 20% coinsurance for Durable Medical Equipment and Prosthetic Devices, while Diabetic Supplies have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with no copay, lab services with no copay, and diagnostic radiological services with a copay of up to $280.00. Therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple (HMO-POS) plan with no copay and no coinsurance. 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, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for some Cardiac and Pulmonary Rehabilitation Services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20 and days 51-100, there is no copay, while days 21-50 have a $214 copay.
Other Services See details
Other Services include Over-the-Counter (OTC) items with no copay and a maximum benefit of $183 every three months, as well as a Meal Benefit with no copay and a required doctor referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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