Wellcare Specialty Simple Focus (HMO C-SNP)
Wellcare · HMO C-SNP · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $9,250
- Drug deductible
- $615
- Medicare star rating
- 3.5 of 5
This is a special needs plan. Only some people can join: Chronic or Disabling Condition.
In plain English
Compared with the 12 other plans in San Francisco County that the same person could join.
What stands out
- No monthly premium
- Dental, vision and hearing extras included
Watch out for
- $1,600 for a 5-day hospital stay, highest of 9 plans here
- $25 for specialist visits, highest of 11 plans here
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$100$0 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$350$0 in premiums + $350 for careHighest of 13 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$2,915$0 in premiums + $2,915 for careHighest of 13 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$25Highest of 11 plans hereReferral neededPlan approval may be needed
- Urgent care$0
- Emergency room$115Not charged if you stay in the hospital within 24 hours
- Hospital stay$800 a day for days 1 to 2, then $0 for days 3 to 90Highest of 9 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$150Highest of 7 plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$0 to $300Depends on the service
- X-rays$50Highest of 10 plans hereReferral neededPlan approval may be needed
- MRI, CT and other scans$0 to $200Depends on the serviceReferral neededPlan approval may be needed
- Ground ambulance$200Highest of 6 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 12 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: you pay $0.Cleanings and exams: plan pays up to $70 a month. Plan pays up to $70 a month for all dental.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $100 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.Plan pays up to $70 a month for hearing tests and aids combined, both ears.
- Over-the-counter items IncludedCovered for things like vitamins, pain relief and bandages.
- Fitness Not included
- Rides to care Not included
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 Specialty Simple Focus (HMO C-SNP), plan number H0562-138, for 2026?”