2027 Medicare Advantage plan

Wellcare Simple Open (PPO): 2027 benefits and costs

Wellcare PPO

CMS plan ID: H0111-001-0 · Plan year: 2027

Wellcare Simple Open (PPO) 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
Drug deductible$700.00
In-network medical out-of-pocket maximum$9,250.00
Organization
Wellcare
Plan organization
WELLCARE OF GEORGIA, INC.
Parent company
Centene Corporation
Plan type
PPO
Part C premium
$0.00
Part D premium
$0.00
Prescription drug coverage
Yes
2027 CMS Star Rating
Standard monthly Medicare Part B premium
$209.50 (estimated)

You must continue to pay your Medicare Part B premium.

Annual medical deductible
None
In-network medical maximum
$9,250.00
Combined in/out-of-network medical maximum
$13,900.00
Out-of-network medical maximum
Not applicable

2027 benefit summary

Doctor visits and medical care

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

$0.00 copay

Service-specific deductible
No

$30.00 copay

Deductible applies
No
Specialist visit

$40.00 copay

Service-specific deductible
No

$55.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Telehealth

$0.00 to $40.00 copay

Service-specific deductible
No

Not summarized. Check coverage with the plan.

Approval required
Yes
Referral required
No
Emergency care

$115.00 copay

Not summarized. Check coverage with the plan.

Urgent care

$15.00 copay

Not summarized. Check coverage with the plan.

Home health

$0.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Dialysis

20% coinsurance

Service-specific deductible
No

20% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Part B chemotherapy and radiation drugs

0% to 20% coinsurance

Deductible applies
No

0% to 50% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

0% to 20% coinsurance

Deductible applies
No

0% to 50% coinsurance

Deductible applies
No
Approval required
Yes
Kidney disease education services

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Medicare-covered chiropractic

$15.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Medicare-covered foot care

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Other health professionals

$0.00 to $40.00 copay

Service-specific deductible
No

$30.00 to $55.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No

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: $475.00 copay per day

Days 6–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$2,075.00 copay per stay

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $0.00 copay per day

Days 21–70: $221.00 copay per day

Days 71–100: $0.00 copay per day

Approval required
Yes
Referral required
No
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
ServiceIn-networkOut-of-networkWhat to know
Outpatient hospital care

$0.00 to $500.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Hospital observation services

$115.00 to $500.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Ambulatory surgical center

$250.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Outpatient blood

$0.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No

Tests, imaging and laboratory services

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

$0.00 to $100.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Laboratory services

$0.00 to $50.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Diagnostic radiology (CT, MRI)

$0.00 to $450.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Therapeutic radiology

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
X-rays

$50.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Mental health and substance use treatment

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

$115.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Intensive outpatient program

$120.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Substance use treatment, individual sessions

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Substance use treatment, group sessions

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Opioid treatment program

$40.00 copay

Service-specific deductible
No

$55.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Mental health, individual sessions

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Mental health, group sessions

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Psychiatry, individual sessions

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Psychiatry, group sessions

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Therapy and rehabilitation

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

$35.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Physical and speech therapy

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Cardiac rehabilitation

$30.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Intensive cardiac rehabilitation

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Pulmonary rehabilitation

$25.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Supervised exercise for peripheral artery disease

$20.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
No
Referral required
No

Ambulance, medical equipment and supplies

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

$350.00 copay

Service-specific deductible
No

$350.00 copay

Deductible applies
No
Approval required
Yes
Air ambulance

$350.00 copay

Service-specific deductible
No

$350.00 copay

Deductible applies
No
Approval required
Yes
Durable medical equipment

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Medical supplies

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic supplies

$0.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic shoes and inserts

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic monitors

0% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes

Dental benefits

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

$40.00 copay

$55.00 copay

Deductible applies
No
Oral examsAdditional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No
Dental X-raysAdditional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No
Other diagnostic dentalAdditional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No
Dental cleaningAdditional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No
FluorideAdditional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No
Other preventive dentalAdditional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No
Restorative dental careAdditional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No
Root canal treatment (endodontics)Additional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No
Gum treatment (periodontics)Additional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No
Oral surgeryAdditional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No
Other dental servicesAdditional plan benefit

$0.00 copay

50% coinsurance

Deductible applies
No

Additional network details

These costs apply to the listed service categories and networks.

Dental benefits: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Diagnostic and preventive dental (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
Comprehensive dental (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No

Vision benefits

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

$0.00 to $40.00 copay

Service-specific deductible
No

$0.00 to $55.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Routine eye examsAdditional plan benefit

$0.00 copay

40% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Medicare-covered eyewear

$0.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Contact lensesAdditional plan benefit

$0.00 copay

40% coinsurance

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

$0.00 copay

40% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Eyeglass lensesAdditional plan benefit

$0.00 copay

40% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Eyeglass framesAdditional plan benefit

$0.00 copay

40% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Additional network details

These costs apply to the listed service categories and networks.

Vision benefits: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Eye exams (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
Other Eye Exam ServicesAdditional plan benefitOut-of-network

40% coinsurance

Deductible applies
No
Eyewear (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
UpgradesAdditional plan benefitOut-of-network

40% coinsurance

Deductible applies
No

Hearing benefits

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

$40.00 copay

Service-specific deductible
No

$55.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Routine hearing examsAdditional plan benefit

$0.00 copay

40% coinsurance

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

$0.00 copay

40% coinsurance

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

$0.00 copay

Service-specific deductible
No

40% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Additional network details

These costs apply to the listed service categories and networks.

Hearing benefits: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Hearing exams (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
Prescription hearing aids (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No

Extra benefits

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

$0.00 copay

Service-specific deductible
No

$0.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Annual physical examAdditional plan benefit

$0.00 copay

Service-specific deductible
No

$0.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0.00 copay

Service-specific deductible
No

$0.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No

Additional services and network costs

Additional network details

These costs apply to the listed service categories and networks.

Additional medical services: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Medicare-covered preventive servicesMedicare-covered careOut-of-network

$0.00 copay

Deductible applies
No
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefitOut-of-network

$0.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Alternative TherapiesAdditional plan benefitOut-of-network

$0.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Glaucoma ScreeningMedicare-covered careOut-of-network

50% coinsurance

Deductible applies
No
Diabetes Self-Management TrainingMedicare-covered careOut-of-network

50% coinsurance

Deductible applies
No
Digital Rectal ExamsMedicare-covered careOut-of-network

50% coinsurance

Deductible applies
No
EKG after a Welcome to Medicare visitMedicare-covered careOut-of-network

50% coinsurance

Deductible applies
No
Medicare Part B insulinMedicare-covered careOut-of-network

$35.00 copay

Deductible applies
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); 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
$14.00
How often this limit applies
Every one month
Shared limit on visits or trips
No

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 6 are exempt from the deductible.

Preferred retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred retail: initial-coverage cost per prescription fill
Drug tier30 days60 days100 days
Tier 1Generic

$0.00

$0.00

$0.00

Tier 2Preferred Brand

25%

25%

25%

Tier 3Non-Preferred Drug

37%

37%

37%

Tier 4Injectable Drugs

15%

15%

15%

Tier 5Specialty Tier

25%

Not listedNot listed
Tier 6Select Care Drugs

$0.00

$0.00

$0.00

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier30 days60 days100 days
Tier 1Generic

$10.00

$20.00

$30.00

Tier 2Preferred Brand

25%

25%

25%

Tier 3Non-Preferred Drug

38%

38%

38%

Tier 4Injectable Drugs

15%

15%

15%

Tier 5Specialty Tier

25%

Not listedNot listed
Tier 6Select Care Drugs

$0.00

$0.00

$0.00

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Preferred mail order costs

Preferred mail order: initial-coverage cost per prescription fill
Drug tier60 days100 days
Tier 1Generic

$0.00

$0.00

Tier 2Preferred Brand

25%

25%

Tier 3Non-Preferred Drug

37%

37%

Tier 4Injectable Drugs

15%

15%

Tier 6Select Care Drugs

$0.00

$0.00

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier60 days100 days
Tier 1Generic

$20.00

$30.00

Tier 2Preferred Brand

25%

25%

Tier 3Non-Preferred Drug

38%

38%

Tier 4Injectable Drugs

15%

15%

Tier 6Select Care Drugs

$0.00

$0.00

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier31 days
Tier 1Generic

$10.00

Tier 2Preferred Brand

25%

Tier 3Non-Preferred Drug

38%

Tier 4Injectable Drugs

15%

Tier 5Specialty Tier

25%

Tier 6Select Care Drugs

$0.00

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier30 days
Tier 1Generic

$10.00

Tier 2Preferred Brand

25%

Tier 3Non-Preferred Drug

38%

Tier 4Injectable Drugs

15%

Tier 5Specialty Tier

25%

Tier 6Select Care Drugs

$0.00

Drug coverage rules and exceptions

Tier 1: Generic

Drugs included in this tier
Both Part D and Excluded Drugs
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 2: Preferred Brand

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 3: Non-Preferred Drug

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 4: Injectable Drugs

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 5: Specialty Tier

Drugs included in this tier
Part D Drugs Only

Tier 6: Select Care Drugs

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No
Initial-coverage prices also apply to drugs exempt from the deductible
Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

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

Georgia