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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 Statewide in AR. 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 $6700.00 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 Enhanced Alternative drug benefit with a yearly prescription drug deductible of $615. After meeting this deductible, you pay no copay for Tier 1 preferred generics and Tier 5 specialty drugs at preferred pharmacies during the initial coverage phase. Other tiers, such as Tier 2 standard generics and Tier 4 non-preferred drugs, require a 25% coinsurance, while Tier 3 preferred brands have a 36% coinsurance at preferred retail pharmacies. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy can benefit from a $0 premium for their Part D coverage. This plan offers a clear pathway to affordable prescription medication, especially for those utilizing preferred pharmacy networks.
Additional Benefits
The Wellcare Simple (HMO-POS) Medicare plan provides comprehensive healthcare coverage with predictable out-of-pocket costs. Members enjoy no copay and no coinsurance for primary care visits, while specialist visits require a $25 copay. For hospital care, inpatient stays feature a daily copay of $395 for the first six days and no copay for days seven through 95, while outpatient hospital services range from no copay up to $400 with no coinsurance. Preventive care, routine eye exams, and preventive dental services are covered with no copay and no coinsurance, helping you manage your health affordably. Emergency care is available with a $130 copay, and urgent care visits require a $40 copay. Additionally, the plan includes valuable extras like over-the-counter items and meal benefits with no copay, alongside allowances for eyewear and hearing aids.
Inpatient Hospital See details
Wellcare Simple (HMO-POS) offers partially covered inpatient hospital services, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require a $395 daily copay for days 1-6 and no copay for days 7-95, while psychiatric stays require a $325 daily copay for days 1-6 and no copay for days 7-90, with no coinsurance required for either service.
Outpatient Services See details
Outpatient services are covered by Wellcare Simple (HMO-POS) with no coinsurance and copays ranging from no copay up to $400 for hospital services, and $130 to $400 per stay for observation services. Additionally, patients will pay a $300 copay for ambulatory surgical center visits, a $40 copay for outpatient substance abuse sessions, and no copay for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by Wellcare Simple (HMO-POS) with a $140.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Simple (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Wellcare Simple (HMO-POS) with a $130 copay and no coinsurance, and urgent care is covered with a $40 copay and no coinsurance. Worldwide emergency and urgent services are partially covered with a $130 copay and no coinsurance up to a $50,000 limit, but 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 $25 copay and no coinsurance. Additional services like telehealth, therapy, and psychiatric care are covered with copays ranging from no copay up to $40 and no coinsurance, though podiatry is not covered and chiropractic services are only partially covered as routine chiropractic care is excluded.
Preventive Services See details
Wellcare Simple (HMO-POS) provides preventive services with no copay and no coinsurance for annual physicals, fitness benefits, and select screenings, while kidney disease education requires a 20% coinsurance and no copay. Other preventive benefits are partially covered, as sub-services like health education, weight management, therapeutic massage, adult day health, and home safety assessments are not covered. Excluded services also include caregiver support, telemonitoring, palliative care, wigs, and nutritional, smoking cessation, and disease management counseling.
Hearing Services See details
Wellcare Simple (HMO-POS) hearing services are partially covered, offering Medicare-covered exams for a $25 copay and annual routine exams, fittings, and prescription hearing aids up to $500 per ear with no copay, deductible, or coinsurance. OTC hearing aids, along with inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) covers vision services with no coinsurance, offering eye exams with a $0 to $25 copay and one routine annual exam with no copay. Eyewear, including glasses and contacts, is also covered with no copay up to a combined maximum benefit of $200 per year.
Dental Services See details
Wellcare Simple (HMO-POS) partially covers dental services, excluding maxillofacial prosthetics, implant services, and orthodontics. Preventive options like exams and cleanings have no copay and no coinsurance, Medicare-covered dental has a $25 copay and no coinsurance, and covered comprehensive services require a 20% coinsurance and no copay up to a $2,000 annual limit.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with prior authorization, requiring a $35 copay and no coinsurance for Medicare Part B insulin. Chemotherapy, radiation, and other Part B drugs are covered with no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Simple (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered by Wellcare Simple (HMO-POS), with durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts requiring a 20% coinsurance and no copay. Diabetic supplies are covered with no copay, and prior authorization is required for these medical equipment and supply benefits.
Diagnostic and Radiological Services See details
Wellcare Simple (HMO-POS) covers diagnostic and radiological services, which require prior authorization. Diagnostic tests and lab services have no copay and no coinsurance, while outpatient X-rays require a $50 copay with no coinsurance, diagnostic radiological services have a copay of up to $400 with no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Wellcare Simple (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Simple (HMO-POS) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with prior authorization required and no coinsurance, and a prior three-day hospital stay is not required. There is no copay for days 1 to 20 and 61 to 100, a $218 copay for days 21 to 60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers Other Services, providing over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered, and the meal benefit requires a doctor referral.
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