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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 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 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 $5000.00 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, your cost will vary depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order. For standard generic drugs, you will pay 25% coinsurance. Preferred brand drugs have a 39% coinsurance at preferred pharmacies, and a 40% coinsurance at standard pharmacies. Specialty drugs have no copay.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers a variety of health benefits with varying cost-sharing. Inpatient hospital stays have copays, while many outpatient services, including primary care physician visits, have no copay. The plan also includes coverage for preventive services, hearing, vision, and dental services, with some services having no copay and others offering maximum annual benefits. This plan provides coverage for emergency services, ambulance services, and home health services with no copay, and covers a range of other services like partial hospitalization, skilled nursing facilities, and diagnostic services with copays or coinsurance. The plan also offers additional benefits such as OTC items, and coverage for home infusion and dialysis services. However, it is important to note that some services are not covered, such as cardiac rehabilitation and additional hours of care.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric inpatient hospital stays. For acute stays, you'll pay a $350 copay for days 1-7 and no copay for days 8-90; for psychiatric stays, you'll pay a $300 copay for days 1-7 and no copay for days 8-90. Additional days for inpatient psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $375, observation services have a copay between $125 and $375, and outpatient substance abuse services have a $40 copay for both individual and group sessions. Ambulatory Surgical Center (ASC) Services have a $250 copay, and outpatient blood services have 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 service.
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 $300 copay, 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 have a $125 copay, while Urgently Needed Services have a $55 copay, and there is no coinsurance for any of these services. Worldwide Urgent Coverage has a $125 copay, and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $30 copay. The plan also covers physician specialist services with a $25 copay, mental health specialty services with a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $30 copay. Additionally, the plan covers additional telehealth benefits with a copay ranging from $0 to $55, and opioid treatment program services with a $25 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services, including an annual physical exam, are covered with no copay. Additional preventive services including Fitness Benefit, Personal Emergency Response System (PERS), and Alternative Therapies are covered with no copay. Kidney Disease Education Services has a 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
The Wellcare Simple (HMO-POS) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $1000 per year, and prescription hearing aids (all types) are covered with no copay. OTC hearing aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Wellcare Simple (HMO-POS) plan covers vision services including eye exams with a copay between $0 and $25, and eyewear with a combined maximum benefit of $400 per year and no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams have no copay and are covered once per year.
Dental Services See details
The Wellcare Simple (HMO-POS) plan covers dental services, including Medicare dental services with a $25 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Orthodontic services are covered up to a maximum of $3,000 per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare Simple (HMO-POS) plan, with prior authorization required. 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. You will pay 20% coinsurance for these services.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers medical equipment, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics and Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 20% coinsurance and no copay for Diabetic Supplies. 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 a copay between $0 and $75, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $300, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered under 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 not covered by the Wellcare Simple (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, but require prior authorization. For days 1-20, there is no copay, for days 21-50 there is a $214 copay, and for days 51-100 there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with no copay and a maximum benefit coverage amount of $164 every three months, but acupuncture, meal benefits, 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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