Wellcare Simple (HMO)
Wellcare · HMO · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Tied for lowest here
- Most you pay in a year for covered care in network
- $9,250
- Higher than most plans here
- Drug deductible
- $700
- Tied for highest here
- Medicare star rating
- No rating yet
In plain English
Compared with the 21 other plans in San Joaquin County that the same person could join.
What stands out
- No monthly premium, tied for lowest here
- $115 for the emergency room, lowest of 20 plans here
Watch out for
- Up to $9,250 a year for covered care, higher than most plans here
- $1,875 for a 5-day hospital stay, higher than most plans here
- $20 for specialist visits, 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$100$0 in premiums + $100 for care2 checkups and 2 lab tests.Uses the highest listed cost for: Lab tests.
- A busier year$355$0 in premiums + $355 for care4 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$3,780$0 in premiums + $3,780 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$20Higher than most plans hereReferral neededPlan approval may be needed
- Urgent care$25Higher than most plans here
- Emergency room$115Lowest of 20 plans hereNot charged if you stay in the hospital within 24 hours
- Hospital stay$375 a day for days 1 to 7, then $0 for days 8 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$150Higher than most plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$0 to $500 or 35%Depends on the service
- X-rays$50Highest of 17 plans hereReferral neededPlan approval may be needed
- MRI, CT and other scans$0 to $500Depends on the serviceReferral neededPlan approval may be needed
- Ground ambulance$250Plan 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 21 other plans in San Joaquin 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 | 38% of the price | 39% 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
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 H5087-035, for 2027?”