2027 Medicare Advantage plan

Wellcare Patriot Simple (HMO): 2027 benefits and costs

Wellcare HMO

CMS plan ID: H5294-014-0 · Plan year: 2027

Wellcare Patriot Simple (HMO) is a 2027 Medicare Advantage plan offered by Wellcare. It is listed in Texas.

2027 plan costs at a glance

Monthly plan premium$0.00
In-network medical out-of-pocket maximum$3,400.00
Organization
Wellcare
Plan organization
SUPERIOR HEALTHPLAN, INC.
Parent company
Centene Corporation
Plan type
HMO
Part C premium
$0.00
Prescription drug coverage
No
2027 CMS Star Rating
Standard monthly Medicare Part B premium
$209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible
None
In-network medical maximum
$3,400.00

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
ServiceIn-networkWhat to know
Primary care doctor

$0.00 copay

Service-specific deductible
No
Specialist visit

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Telehealth

$0.00 to $25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Emergency care

$150.00 copay

Urgent care

$25.00 copay

Home health

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Dialysis

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
Yes
Part B chemotherapy and radiation drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Kidney disease education services

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
Yes
Medicare-covered chiropractic

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Medicare-covered foot care

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Other health professionals

$0.00 to $10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–5: $275.00 copay per day

Days 6–90: $0.00 copay per day

Approval required
Yes
Referral required
Yes
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$0.00 copay per stay

Days 1–5: $225.00 copay per day

Days 6–90: $0.00 copay per day

Approval required
Yes
Referral required
Yes
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $0.00 copay per day

Days 21–40: $221.00 copay per day

Days 41–100: $0.00 copay per day

Approval required
Yes
Referral required
Yes
Benefit period
Per Admission or Per Stay

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkWhat to know
Outpatient hospital care

$0.00 to $200.00 copay

Service-specific deductible
No
Hospital observation services

$150.00 to $200.00 copay

Service-specific deductible
No
Ambulatory surgical center

$125.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Outpatient blood

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkWhat to know
Diagnostic procedures and tests

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Laboratory services

$0.00 to $50.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Diagnostic radiology (CT, MRI)

$0.00 to $200.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Therapeutic radiology

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
X-rays

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkWhat to know
Partial hospitalization

$190.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Intensive outpatient program

$200.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Substance use treatment, individual sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Substance use treatment, group sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Opioid treatment program

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Mental health, individual sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Mental health, group sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Psychiatry, individual sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Psychiatry, group sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkWhat to know
Occupational therapy

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Physical and speech therapy

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Cardiac rehabilitation

$55.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Intensive cardiac rehabilitation

$70.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Pulmonary rehabilitation

$40.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Supervised exercise for peripheral artery disease

$30.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkWhat to know
Ground ambulance

$225.00 copay

Service-specific deductible
No
Approval required
Yes
Air ambulance

$225.00 copay

Service-specific deductible
No
Approval required
Yes
Durable medical equipment

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Medical supplies

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic supplies

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Diabetic shoes and inserts

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic monitors

0% coinsurance

Service-specific deductible
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered dental

$10.00 copay

Oral examsAdditional plan benefit

$0.00 copay

Dental X-raysAdditional plan benefit

$0.00 copay

Other diagnostic dentalAdditional plan benefit

$0.00 copay

Dental cleaningAdditional plan benefit

$0.00 copay

FluorideAdditional plan benefit

$0.00 copay

Other preventive dentalAdditional plan benefit

$0.00 copay

Restorative dental careAdditional plan benefit

$0.00 copay

Root canal treatment (endodontics)Additional plan benefit

$0.00 copay

Gum treatment (periodontics)Additional plan benefit

$0.00 copay

Removable dentures (prosthodontics)Additional plan benefit

$0.00 copay

Fixed dental restorations (prosthodontics)Additional plan benefit

$0.00 copay

Oral surgeryAdditional plan benefit

$0.00 copay

Other dental servicesAdditional plan benefit

$0.00 copay

Vision benefits

Vision benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered eye exams

$0.00 to $10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Routine eye examsAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
No
Medicare-covered eyewear

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Contact lensesAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
No
Eyeglasses, lenses and framesAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
No
Eyeglass lensesAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
No
Eyeglass framesAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered hearing exams

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Routine hearing examsAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
No
Hearing aid fitting and evaluationAdditional plan benefit

$0.00 copay

Approval required
Yes
Referral required
No
Prescription hearing aids (all types)Additional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkWhat to know
Over-the-counter health itemsAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Limited-duration mealsAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Annual physical examAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Allowances and optional benefits

OTC DVH

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance
Over-the-counter health items; Oral Exams; Dental X-Rays; Other Diagnostic Dental Services; Dental cleaning; Fluoride Treatment; Other Preventive Dental Services; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Removable dentures (prosthodontics); Fixed dental restorations (prosthodontics); Oral and Maxillofacial Surgery; Adjunctive General Services; Routine Eye Exams; Other Eye Exam Services; Contact Lenses; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames; Upgrades; Routine Hearing Exams; Hearing aid fitting and evaluation; Prescription Hearing Aids (all types)
How benefits are provided
Debit Card; Reimbursement
Advance choice of benefits required
No
Shared benefit limit
$50.00
How often this limit applies
Every one month
Shared limit on visits or trips
No

Prescription drug coverage

This plan does not include a Part D prescription drug benefit.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

View all locations 51 county listings across 1 state or territory

Texas