Wellcare TexanPlus Patriot Giveback (HMO-POS)

SELECTCARE OF TEXAS, INC. · 2026 plan year

Plan ID H4506-010-000

HMOPOS★ 4 CMS Stars
MOOP (in-network)
$3,000
MOOP (combined)
—
Monthly premium
$0/mo
Prescription drugs
Not included

Plan information

Contract / Plan / Segment
H4506-010-000
Medical deductible
$0 — no deductible
Also owed
Your Medicare Part B premium, paid separately

More SELECTCARE OF TEXAS, INC. plans in TX

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — Acute$350 per stay
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — Psychiatric$300 per stay
Worldwide Urgent Care Coverage$150

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual SessionsNo charge
Mental Health — Group SessionsNo charge
Supplemental Health BenefitsSee plan details

Other

BenefitIn-network
Cardiac & Pulmonary RehabilitationSee plan details
Cardiac Rehabilitation — Additional Sessions$50
Vision — Eyewear UpgradesNo charge
Hearing — Exams$35
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)No charge
Diabetic SuppliesNo charge
Psychiatric Services — Group SessionsNo charge
Worldwide Emergency Coverage$150
Skilled Nursing Facility (SNF)$0/day for days 1–20, $218/day for days 21–40, $0 after
Intensive Cardiac Rehabilitation — Additional Sessions$65
Pulmonary Rehabilitation — Additional Sessions$40
Supervised Exercise Therapy (SET)$30
Emergency Services$150
Urgently Needed Services$25
Worldwide Emergency & Urgent CoverageSee plan details
Psychiatric Services — Individual SessionsNo charge
Partial Hospitalization Program$175
Intensive Outpatient Program (IOP)$175
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Chiropractic Services$20
Occupational Therapy Services$10
Physician Specialist Services$35
Podiatry Services$35
Other Health Care Professional Services$0-$35
Psychiatric ServicesSee plan details
Physical Therapy & Speech-Language Pathology$10
Additional Telehealth Services (Part B)$0-$35
Opioid Treatment Program Services$35
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & TestsNo charge
Laboratory Services$0-$50
Radiological ServicesSee plan details
Diagnostic Radiology$0-$200
Therapeutic Radiology20% coinsurance
X-Ray Services$25
Outpatient Hospital Services$0-$225
Hospital Observation Services$150-$225 per stay
Ambulatory Surgical Center (ASC)$75
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual SessionsNo charge
Substance Abuse — Group SessionsNo charge
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance$250
Air Ambulance$250
Durable Medical Equipment (DME)20% coinsurance
Prosthetics & OrthoticsSee plan details
Prosthetic Devices20% coinsurance
Medical Supplies20% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic Therapeutic Shoes & Inserts20% coinsurance
Dialysis Services20% coinsurance
Meal BenefitNo charge
Medicare-Covered Preventive ServicesSee plan details
Annual Physical ExamNo charge
Fitness BenefitNo charge
Remote Access TechnologiesNo charge
Alternative TherapiesNo charge
Kidney Disease Education Services20% coinsurance
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)$35
Dental — Medicare-Covered Services$35
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — Diagnostic ServicesNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — Fluoride TreatmentNo charge
Dental — Other Preventive ServicesNo charge
Dental — ComprehensiveSee plan details
Dental — Restorative ServicesNo charge
Dental — Endodontics (Root Canal)No charge
Dental — Periodontics (Gum Care)No charge
Dental — Removable Prosthodontics (Dentures)No charge
Dental — Fixed Prosthodontics (Bridges)No charge
Dental — Oral & Maxillofacial SurgeryNo charge
Dental — Adjunctive General ServicesNo charge
Vision — Eye Exams$0-$35
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Vision — Eyeglass LensesNo charge
Vision — Eyeglass FramesNo charge

Service area

  • TX: 16 counties

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