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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 All counties in KY. 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 $7000.00 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) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, you will pay no copay when filling your prescriptions through preferred retail pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order services are also available for generic drugs with low copayments starting at $5 for a one-month supply. Brand-name and specialty medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 33% to 34% coinsurance depending on your pharmacy selection.
Additional Benefits
The Wellcare Simple (HMO-POS) plan offers robust coverage for essential medical services with predictable out-of-pocket costs, including no copay or coinsurance for primary care visits and preventive services. Specialists require a $35 copay, while emergency care is covered with a $115 copay and urgent care with a $40 copay, both with no deductible or coinsurance. Inpatient hospital stays feature no coinsurance and a daily copay of $375 for the first seven days of acute care, with no copay for subsequent days up to day 95. For supplemental care, this plan provides excellent value with no copay or coinsurance for routine dental, vision, and hearing services. Dental benefits cover preventive and comprehensive services up to a $3,000 yearly maximum, while routine eyewear is covered up to $300 annually and prescription hearing aids are covered up to $750 per ear. Additionally, members can take advantage of no copay for home health services and select over-the-counter items to support their daily health needs.
Inpatient Hospital See details
Inpatient hospital care under Wellcare Simple (HMO-POS) is partially covered with no coinsurance, featuring a daily copay of $375 for days 1-7 of acute stays (no copay for days 8-95) and $295 for days 1-7 of psychiatric stays (no copay for days 8-90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Simple (HMO-POS) covers outpatient hospital services with no coinsurance and a copay ranging from no copay to $450, and ambulatory surgical center services with a $300 copay and no coinsurance. Outpatient substance abuse sessions require a $40 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Simple (HMO-POS) covers partial hospitalization services with a $105.00 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, but transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Wellcare Simple (HMO-POS) covers emergency services with a $115 copay and urgent care with a $40 copay, both with no coinsurance and no deductible. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple (HMO-POS) features no copay and no coinsurance for primary care provider visits, while specialist visits require a $35 copay and no coinsurance. Therapy, psychiatric, and mental health services are covered with no coinsurance and copays ranging from $30 to $40, though chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Simple (HMO-POS) offers partially covered preventive services, featuring annual physical exams, select screenings, and supplemental benefits like alternative therapies and fitness programs with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, though several services including health education, nutritional therapy, and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Simple (HMO-POS) hearing services are partially covered with no deductible, offering Medicare-covered exams for a $35 copay and no coinsurance, plus annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay and no coinsurance, while OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Simple (HMO-POS) partially covers vision services with no copay and no coinsurance, offering one routine eye exam per year while excluding other eye exam services. Covered eyewear, including contact lenses and eyeglasses, also features no copay or coinsurance up to a $300 annual maximum limit.
Dental Services See details
Dental Services are partially covered by Wellcare Simple (HMO-POS), offering Medicare-covered dental care for a $35 copay and no coinsurance, and other preventive and comprehensive services with no copay and no coinsurance up to a $3,000 yearly maximum. However, maxillofacial prosthetics, implant services, and orthodontics are not covered, and prior authorization is required for most services.
Home Infusion bundled Services See details
Wellcare Simple (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Wellcare Simple (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple (HMO-POS) covers durable medical equipment, 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 Simple (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and no coinsurance. Diagnostic tests require a $0 to $75 copay with no coinsurance, diagnostic radiological services have a $0 minimum copay, outpatient X-rays require a $50 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellcare Simple (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Wellcare Simple (HMO-POS) with no coinsurance, but some services are covered while standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($25 copay), and SET for PAD services ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and 61 to 100, and a $218 daily copay for days 21 to 60. Prior authorization is required, and additional days beyond the 100-day Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple (HMO-POS) partially covers Other Services, offering Over-the-Counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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