Wellcare Specialty Simple Focus (HMO C-SNP)
Wellcare · HMO C-SNP · 2027 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
- $700
- Tied for highest here
- Medicare star rating
- No rating yet
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
- $115 for the emergency room, lower than most plans here
- Dental, vision and hearing extras included
Watch out for
- $1,600 for a 5-day hospital stay, higher than most plans here
- $25 for specialist visits, highest of 11 plans here
- $700 drug deductible, tied for highest 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 careHighest of 13 plans here2 checkups and 2 lab tests.Uses the highest listed cost for: Lab tests.
- A busier year$300$0 in premiums + $300 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$2,865$0 in premiums + $2,865 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$115Lower than most plans hereNot 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 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$150Highest of 6 plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$0 to $300Depends on the service
- X-rays$0Referral neededPlan approval may be needed
- MRI, CT and other scans$0 to $200Depends on the serviceReferral neededPlan approval may be needed
- Ground ambulance$150Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $221 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 2027. 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 2027 booklet (PDF)
What medicines cost
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Generic | $0 | $10 |
| 2Preferred BrandAfter the deductible | 25% of the price | 25% of the price |
| 3Non-Preferred DrugAfter the deductible | 39% of the price | 39% of the price |
| 4Injectable DrugsAfter the deductible | 15% of the price | 15% 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 $700 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 2027, 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 covered. 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 $350 a year per ear.
- Over-the-counter items IncludedCovered for things like vitamins, pain relief and bandages.
- Fitness Not included
- Rides to care Not included
What changed from 2026
- Drug deductible2026$6152027$700
- X-rays2026$502027$0
- Ground ambulance2026$2002027$150
- Skilled nursing facility2026$0 for days 1 to 20, then $218 a day for days 21 to 70, then $0 for days 71 to 1002027$0 for days 1 to 20, then $221 a day for days 21 to 70, then $0 for days 71 to 100
- Dental2026Cleanings 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 dental2027Cleanings and exams covered. Fillings, crowns and dentures covered
- Hearing2026Hearing test: $0. Hearing aids covered. Plan pays up to $70 a month for hearing tests and aids combined, both ears2027Hearing test: $0. Hearing aids covered. Hearing aids: plan pays up to $350 a year per ear
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 2027?”