Wellcare Simple (HMO)
Wellcare · HMO · 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
- $4,500
- Higher than most plans here
- Drug deductible
- $700
- Tied for highest here
- Medicare star rating
- No rating yet
In plain English
Compared with the 61 other plans in Orange County that the same person could join.
What stands out
- No monthly premium
Watch out for
- Up to $4,500 a year for covered care, higher than most plans here
- $1,000 for a 5-day hospital stay, higher than most plans here
- $700 drug deductible, tied for highest here
- No vision extra, though most plans here have one
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$230$0 in premiums + $230 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$1,830$0 in premiums + $1,830 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$0
- Emergency room$130Not charged if you stay in the hospital within 24 hours
- Hospital stay$250 a day for days 1 to 4, then $0 for days 5 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$50Higher than most plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$0 to $300Depends on the service
- X-rays$30Higher than most plans hereReferral neededPlan approval may be needed
- MRI, CT and other scans$0 to $100Depends on the serviceReferral neededPlan approval may be needed
- Ground ambulance$200Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $221 a day for days 21 to 50, then $0 for days 51 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 61 other plans in Orange County that the same person could join. Ask the plan for its 2027 Evidence of Coverage booklet for the full rules.
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 | 35% of the price | 35% of the price |
| 4Injectable DrugsAfter the deductible | 1% of the price | 1% 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 Not included
- Hearing Not included
- Over-the-counter items Not included
- Fitness Not included
- Rides to care Not included
What changed from 2026
- Drug deductible2026$6152027$700
- Outpatient hospital care2026$0 to $2002027$0 to $300
- X-rays2026$252027$30
- Ground ambulance2026$1502027$200
- Skilled nursing facility2026$0 for days 1 to 20, then $218 a day for days 21 to 50, then $0 for days 51 to 1002027$0 for days 1 to 20, then $221 a day for days 21 to 50, then $0 for days 51 to 100
- Dental2026Cleanings and exams: $0. Fillings, crowns and dentures: you pay $02027Cleanings and exams covered. Fillings, crowns and dentures covered
- Vision2026Yearly eye exam: $02027Not covered
- Hearing2026Hearing test: $0. Hearing aids covered. Hearing aids: plan pays up to $350 a year per ear2027Not covered
- Fitness2026Includes gym or fitness classes2027Not covered
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 Simple (HMO), plan number H5087-005, for 2027?”