Wellcare Low Premium (HMO)
Wellcare · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $33
- Higher than most plans here
- Most you pay in a year for covered care in network
- $9,250
- Tied for highest here
- Drug deductible
- $615
- Tied for highest here
- Medicare star rating
- 3.5 of 5
In plain English
Compared with the 28 other plans in San Francisco County that the same person could join.
What stands out
- Dental, vision and hearing extras included
Watch out for
- $33 monthly premium, higher than most plans here
- Up to $9,250 a year for covered care, tied for highest here
- $2,025 for a 5-day hospital stay, higher than most plans here
- $25 for urgent care, higher than most plans here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$496$396 in premiums + $100 for careHigher than most plans here2 checkups and 2 lab tests.Uses the highest listed cost for: Lab tests.
- A busier year$646$396 in premiums + $250 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Uses the highest listed cost for: Lab tests.
- A hard year$3,611$396 in premiums + $3,215 for careHigher than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Uses the highest listed cost for: Lab tests, MRI, CT and other scans.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$0Referral neededPlan approval may be needed
- Urgent care$25Higher than most plans here
- Emergency room$115Not charged if you stay in the hospital within 24 hours
- Hospital stay$405 a day for days 1 to 5, then $0 for days 6 to 90Higher than most plans hereReferral neededPlan approval may be needed
- Lab tests$0 to $50Depends on the serviceReferral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$200Higher than most plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$0 to $250Depends on the service
- X-rays$25Higher than most plans hereReferral neededPlan approval may be needed
- MRI, CT and other scans$0 to $250Depends on the serviceReferral neededPlan approval may be needed
- Ground ambulance$275Higher than most plans herePlan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $218 a day for days 21 to 70, then $0 for days 71 to 100Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 28 other plans in San Francisco County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Preferred Generic | $0 | $5 |
| 2Generic | $0 | $10 |
| 3Preferred BrandAfter the deductible | 25% of the price | 25% of the price |
| 4Non-Preferred DrugAfter the deductible | 35% of the price | 35% of the price |
| 5Specialty TierAfter the deductible | 25% of the price | 25% of the price |
| 6Select Care Drugs | $0 | $0 |
For a 1-month supply. The $615 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures covered.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $100 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.Hearing aids: plan pays up to $500 a year per ear.
- Over-the-counter items IncludedCovered for things like vitamins, pain relief and bandages.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included12 one-way rides to medical visits a year.
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Wellcare Low Premium (HMO), plan number H0562-097, for 2026?”