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Wellcare Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO-POS) in 2025, please refer to our full plan details page.
Wellcare Assist (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 Assist (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 Assist (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 Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.40. 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 $590.00 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 Assist (HMO-POS) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $19 or $20 copay, while preferred brand drugs have 36% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers a range of benefits with varying costs. Hospital stays have a copay, with acute inpatient stays costing $350 for days 1-6, and psychiatric care costing $325 for days 1-5. Outpatient services have copays ranging from $0 to $325, and emergency services have a $125 copay. This plan also includes coverage for primary care with no copay, along with other services like hearing and vision exams, which have no copay. There is also coverage for dental services, including oral exams and cleanings, with no copay. Additionally, the plan covers home health services with no copay, and offers over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Wellcare Assist (HMO-POS) plan. For acute inpatient hospital stays, you will pay a $350 copay for days 1-6, and no copay for days 7-90; for inpatient psychiatric care, you will pay a $325 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and observation services, are covered under this plan. Outpatient hospital services have a copay between $0 and $325, observation services have a copay between $125 and $325, and ambulatory surgical center services have a $250 copay. Outpatient substance abuse services and outpatient blood services are also covered, with individual and group sessions for substance abuse each having a $40 copay, and outpatient blood services having no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Assist (HMO-POS) plan, and requires prior authorization. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered, with a $300 copay for each service. Transportation services to a plan-approved health-related location are covered with no copay for up to 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Assist (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services have a $25 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $25 copay, and physical therapy and speech-language pathology services with a $30 copay. The plan also covers mental health and psychiatric services with a $40 copay for individual and group sessions, other health care professional services with a copay between $0 and $25, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $25 copay. Podiatry services are not covered.
Preventive Services See details
The Wellcare Assist (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, are covered with no copay. Kidney disease education services are covered with 20% coinsurance.
Hearing Services See details
Wellcare Assist (HMO-POS) covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, all of which require prior authorization. Prescription hearing aids are covered with a maximum benefit of $750 per year, and prescription hearing aids of all types have no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Wellcare Assist (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $25, and eyewear with a combined maximum benefit of $300 every year and no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $25 copay, and other dental services such as oral exams, dental x-rays, and cleanings with no copay. Orthodontic services have a maximum benefit of $2000 per year, while other services like maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. 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 Assist (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance for Medicare-covered items, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $275, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Assist (HMO-POS) plan. 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 are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Assist (HMO-POS) plan, but require prior authorization. For days 1-20 and 51-100, there is no copay, while days 21-50 have a copay of $214.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits. Over-the-Counter (OTC) Items have no copay and a maximum benefit of $156 every three months, while Meal Benefits also have no copay and require a doctor referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services and Private Duty Nursing Services are not covered.
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