2027 Medicare Advantage plan

Wellcare Patriot Simple (HMO-POS): 2027 benefits and costs

Wellcare HMO-POS

CMS plan ID: H1112-034-0 · Plan year: 2027

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

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: WELLCARE OF GEORGIA, INC.
Parent company: Centene Corporation
Plan type: HMO-POS
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
Combined in/out-of-network medical deductible: None
Out-of-network medical deductible: None
In-network medical maximum: $3,400.00
Combined in/out-of-network medical maximum: Not applicable
Out-of-network medical maximum: Not applicable

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0.00 copay Service-specific deductible No
Specialist visit	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Telehealth	$0.00 to $35.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Emergency care	$150.00 copay
Urgent care	$35.00 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	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Medicare-covered foot care	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Other health professionals	$0.00 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.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–5: $350.00 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 1–4: $325.00 copay per day Days 5–90: $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 Original Medicare

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

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$0.00 to $300.00 copay Service-specific deductible No
Hospital observation services	$150.00 to $300.00 copay Service-specific deductible No
Ambulatory surgical center	$250.00 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
Service	In-network	What to know
Diagnostic procedures and tests	$0.00 to $20.00 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 $300.00 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	$20.00 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
Service	In-network	What 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	$0.00 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
Service	In-network	What to know
Occupational therapy	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Physical and speech therapy	$0.00 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
Service	In-network	What to know
Ground ambulance	$200.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	$200.00 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
Service	In-network	Point-of-service
Medicare-covered dental	$0.00 copay	Not summarized. Check coverage with the plan.
Oral examsAdditional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Dental X-raysAdditional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Other diagnostic dentalAdditional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Dental cleaningAdditional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
FluorideAdditional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Other preventive dentalAdditional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Restorative dental careAdditional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Root canal treatment (endodontics)Additional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Gum treatment (periodontics)Additional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Removable dentures (prosthodontics)Additional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Fixed dental restorations (prosthodontics)Additional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Oral surgeryAdditional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No
Other dental servicesAdditional plan benefit	$0.00 copay	25% coinsurance Deductible applies No Dollar benefit limit applies No

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0.00 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
Service	In-network	What to know
Medicare-covered hearing exams	$0.00 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
Service	In-network	What 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: $95.00
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 141 county listings across 1 state or territory