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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 2025, 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 All counties in KY. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $108.00. 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 $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 $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 Giveback (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $420.00. In the initial coverage phase, after the deductible is met, you will pay a $0 copay for preferred generic drugs at preferred and mail-order pharmacies. Standard generic drugs have a 25% coinsurance, and preferred brand drugs have a 48% coinsurance. The plan has a $0 copay for drugs in the specialty tier. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Giveback (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with copays, outpatient services with copays, and partial hospitalization with a $105 copay. The plan covers emergency services with a $125 copay and primary care services with no copay. Additional benefits include coverage for preventive services with no copay, hearing exams with a $40 copay, and vision services with no copay, including eyewear up to a combined maximum benefit of $100 per year. The plan also covers dental services with no copay for most services, and offers coverage for home infusion, dialysis, medical equipment, and diagnostic services with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you pay a $450 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $375 copay for days 1-5, and no copay for days 6-90. Additional Days, and Non-Medicare-covered Stay for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a copay between $125 and $350, and Ambulatory Surgical Center (ASC) Services with a $200 copay. Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $40, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Giveback (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
For the Wellcare Giveback (HMO-POS) plan, Ambulance Services have a $320 copay for both ground and air ambulance services, with 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 by the Wellcare Giveback (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services have a $30 copay, but there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Giveback (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay. The plan also covers physician specialist services with a $40 copay, mental health specialty services, psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $40 copay, additional telehealth services with a copay between $0 and $40, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Alternative Therapies, and Remote Access Technologies, are covered with a $0 copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The Wellcare Giveback (HMO-POS) plan covers hearing exams with a $40 copay and also covers routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Wellcare Giveback (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$40 and routine eye exams with no copay, and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. The plan offers a combined maximum benefit of $100 per year for all eyewear.
Dental Services See details
The Wellcare Giveback (HMO-POS) plan covers Medicare Dental Services with a $40 copay and offers other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay. Orthodontic services are covered up to a maximum of $1000 per year, while prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay for Medicare Part B Insulin Drugs. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Giveback (HMO-POS) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Giveback (HMO-POS) plan, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies, and no copay. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. 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 and tests with a copay between $0 and $50, and lab services with no copay. Outpatient X-ray services have a $45 copay, while diagnostic radiological services have a copay up to $350, and therapeutic radiological services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback (HMO-POS) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Giveback (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Giveback (HMO-POS) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, but for days 21-60, there is a $214 copay.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with no copay, up to a maximum of $40 every three months, and the plan also covers Nicotine Replacement Therapy (NRT) and Naloxone as an OTC benefit. Acupuncture, Meal Benefit, 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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