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Wellcare Giveback (HMO-POS)

Wellcare Health Plans, Inc.
Wellcare Giveback (HMO-POS) H0908-005 Plan Details
3.5 out of 5 stars

Wellcare Giveback (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Wellcare Health Plans, Inc.
Plan ID: H0908-005

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$0.00
Monthly Premium

Wellcare Giveback (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Wellcare Health Plans, Inc.
Plan ID: H0908-005

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Wellcare Health Plans, Inc.
Wellcare Giveback (HMO-POS) H0908-005 Plan Details
3.5 out of 5 stars

Wellcare Giveback (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Wellcare Health Plans, Inc.
Plan ID: H0908-005

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$0.00
Monthly Premium

Ohio Counties Served

Clark Champaign Greene Shelby Hamilton Butler Preble Warren Miami Montgomery Clermont Brown Darke Logan Crawford Hardin Wyandot Seneca Erie Hancock Auglaize Wood Sandusky Ottawa Lucas Williams Fulton Defiance Henry Paulding Putnam Huron Mercer Allen Van Wert Hocking Vinton Ross Washington Athens Adams Clinton Highland Pike Jackson Gallia Scioto Lawrence Meigs Delaware Union Franklin Madison Pickaway Licking Knox Morrow Coshocton Holmes Richland Fairfield Muskingum Perry Fayette Marion Morgan Tuscarawas Noble Belmont Monroe Columbiana Guernsey Jefferson Harrison Carroll Geauga Cuyahoga Medina Lorain Ashtabula Lake Summit Trumbull Portage Wayne Stark Ashland Mahoning

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $420
Out of Pocket Max In-Network: $7500
Out-of-Network: N/A
Initial Coverage Limit $2000
Catastrophic Coverage Limit $2,000
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $50
Prior Authorization Required for Doctor Specialty Visit
Prior authorization required
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$455 per day for days 1 to 5
$0 per day for days 6 to 90
Prior Authorization Required for Acute Hospital Services
Prior authorization required
Urgent Care
Copayment for Urgent Care $45
Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $110
Maximum Plan Benefit of $50,000
Emergency Room Visit
Copayment for Emergency Care $110
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $110
Maximum Plan Benefit of $50,000
Ambulance Transportation
In-Network:

Ground Ambulance:
Coinsurance for Ground Ambulance Services 30%

Air Ambulance:
Coinsurance for Air Ambulance Services 30%
Prior Authorization Required for Air Ambulance
Prior authorization required

Health Care Services and Medical Supplies

Wellcare Giveback (HMO-POS) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Copayment for Medicare-covered Chiropractic Services $15
Prior Authorization Required for Chiropractic Services
Prior authorization required
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Copayment for Medicare-covered Diabetic Supplies $0
Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20%
Durable Medical Eqipment (DME)
In-Network:
Coinsurance for Medicare-covered Durable Medical Equipment 20%
Prior Authorization Required for Durable Medical Equipment
Prior authorization required
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0 to $100
Copayment for Medicare-covered Lab Services $0 to $50
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
Diagnostic Tests, Lab and Radiology Services, and X-Rays Outpatient Diagnostic Procedures/Tests: The minimum cost share is for spirometry testing and specified testing-related services. The maximum cost share is for all other services. The removal of abnormal tissue and/or polyps during a colonoscopy performed as a preventive screening for colorectal cancer will be covered at a $0 co-payment.

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $0
Coinsurance for Medicare-covered Diagnostic Radiological Services 30%
Coinsurance for Medicare-covered Therapeutic Radiological Services 20%
Copayment for Medicare-covered X-Ray Services $25
Prior authorization required
Home Health Care
In-Network:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Prior authorization required
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$400 per day for days 1 to 5
$0 per day for days 6 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Mental Health Outpatient Care
In-Network:
Coinsurance for Medicare-covered Individual Sessions 20%
Coinsurance for Medicare-covered Group Sessions 20%
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0
Coinsurance for Medicare Covered Outpatient Hospital Services 30%
Prior Authorization Required for Outpatient Hospital Services
Outpatient Hospital and ASC Services Outpatient Hospital Services: The $0 co-payment is for diagnostic colonoscopy. The coinsurance is for all other outpatient services.

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per stay $110
Coinsurance for Medicare Covered Observation Services - Per stay 30%
Outpatient Services/Surgery Observation Services: The co-payment is charged when a member enters observation status through the ER/ED. The coinsurance is charged when a member enters observation status through an outpatient facility.

Ambulatory Surgical Center Services:
Coinsurance for Ambulatory Surgical Center Services 20%
Prior Authorization Required for Ambulatory Surgical Center Services
Prior authorization required
Outpatient Substance Abuse Care
In-Network:
Coinsurance for Medicare-covered Individual Sessions 20%
Coinsurance for Medicare-covered Group Sessions 20%
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Over-the-counter (OTC) Items
OTC allowance of $40 every quarter is loaded into the Wellcare Spendables card on a quarterly basis. Benefit is designed to allow members the flexibility to purchase OTC items at participating retailers, online, phone order, or catalog order. Benefit expires at end of quarter if unused.
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $50
Prior Authorization Required for Podiatry Services
Prior authorization required
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0 per day for days 1 to 20
$214 per day for days 21 to 60
$0 per day for days 61 to 100
Prior Authorization Required for Skilled Nursing Facility Services
Prior authorization required

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:

Medicare Covered Preventive Dental:
Copayment for Office Visit $50
Prior Authorization Required for Medicare Covered Preventive Dental

Non-Medicare Covered Preventive Dental:
Copayment for Non-medicare preventive $0
Copayment for Oral exams $0
  • Maximum 2 visits every year
Copayment for Dental x-rays $0
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Other diagnostic services $0
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Prophylaxis $0
  • Maximum 2 visits every year
Copayment for Fluoride treatment $0
  • Maximum 1 visit every year
Copayment for Other preventive services $0
  • Maximum 1 visit (Please see Evidence of Coverage for details)

Non-Medicare Covered Comprehensive Dental:
Copayment for Non-medicare comprehensive $0
Copayment for Adjunctive general services $0
  • Maximum 1 visit (Please see Evidence of Coverage for details)

Prior authorization required

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0 to $50
Copayment for Routine Eye Exams $0
  • Maximum 1 Routine Eye Exam every year

Eyewear:
Copayment for Medicare-Covered Benefits $0
Maximum Plan Allowance of $200 every year

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $50
Copayment for Routine Hearing Exams $0
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0
  • Maximum 1 visit every year
Prior Authorization Required for Hearing Exams
Prior authorization required

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
    • Tobacco use cessation
    Yearly "Wellness" visit

    Prescription Drug Costs and Coverage

    The Wellcare Giveback (HMO-POS) plan offers the following prescription drug coverage, with an annual drug deductible of $420 (excludes Tiers 1, 2 and 6) per year.

    Coverage
    Cost
    Coverage & Cost
    Annual Drug Deductible $420 (excludes Tiers 1, 2 and 6)
    Preferred Generic
    • Preferred cost-share mail order $0.00
    • Standard retail $5.00
    • Preferred cost-share retail $0.00
    • Standard mail order $5.00
    Generic
    • Preferred cost-share mail order $0.00
    • Standard retail $10.00
    • Preferred cost-share retail $0.00
    • Standard mail order $10.00
    Select Care Drugs
    • Preferred cost-share mail order $0.00
    • Standard retail $0.00
    • Preferred cost-share retail $0.00
    • Standard mail order $0.00
    Annual Drug Deductible $420 (excludes Tiers 1, 2 and 6)
    Preferred Generic
    • Preferred cost-share mail order $0.00
    • Standard retail $10.00
    • Preferred cost-share retail $0.00
    • Standard mail order $10.00
    Generic
    • Preferred cost-share mail order $0.00
    • Standard retail $20.00
    • Preferred cost-share retail $0.00
    • Standard mail order $20.00
    Select Care Drugs
    • Preferred cost-share mail order $0.00
    • Standard retail $0.00
    • Preferred cost-share retail $0.00
    • Standard mail order $0.00
    Annual Drug Deductible $420 (excludes Tiers 1, 2 and 6)
    Preferred Generic
    • Preferred cost-share mail order $0.00
    • Standard retail $15.00
    • Preferred cost-share retail $0.00
    • Standard mail order $15.00
    Generic
    • Preferred cost-share mail order $0.00
    • Standard retail $30.00
    • Preferred cost-share retail $0.00
    • Standard mail order $30.00
    Select Care Drugs
    • Preferred cost-share mail order $0.00
    • Standard retail $0.00
    • Preferred cost-share retail $0.00
    • Standard mail order $0.00
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