2027 Medicare Advantage plan

Wellcare Simple Value (HMO): 2027 benefits and costs

Wellcare HMO

CMS plan ID: H5294-026-0 · Plan year: 2027

Wellcare Simple Value (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

Drug deductible$700.00

In-network medical out-of-pocket maximum$9,850.00

Organization: Wellcare
Plan organization: SUPERIOR HEALTHPLAN, INC.
Parent company: Centene Corporation
Plan type: HMO
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.

In-network medical deductible: None
In-network medical maximum: $9,850.00

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	$50.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Telehealth	$0.00 to $50.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Emergency care	$115.00 copay
Urgent care	$40.00 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	$15.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Medicare-covered foot care	$50.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Other health professionals	$0.00 to $50.00 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 1–4: $425.00 copay per day Days 5–90: $0.00 copay per day	Approval required Yes Referral required Yes Benefit period Per Admission or Per Stay
Inpatient mental health care	$0.00 copay per stay Days 1–4: $425.00 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 21–70: $221.00 copay per day Days 71–100: $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
Service	In-network	What to know
Outpatient hospital care	0% to 30% coinsurance Service-specific deductible No
Hospital observation services	$115.00 copay; 30% coinsurance Service-specific deductible No
Ambulatory surgical center	20% coinsurance 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% to 20% coinsurance 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% to 20% coinsurance 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	$50.00 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	$115.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Intensive outpatient program	$120.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Substance use treatment, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Substance use treatment, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Opioid treatment program	$50.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Psychiatry, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Psychiatry, group sessions	20% coinsurance 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	$25.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Physical and speech therapy	$25.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Cardiac rehabilitation	$30.00 copay Service-specific deductible No	Approval required No Referral required Yes
Intensive cardiac rehabilitation	$40.00 copay Service-specific deductible No	Approval required No Referral required Yes
Pulmonary rehabilitation	$25.00 copay Service-specific deductible No	Approval required No Referral required Yes
Supervised exercise for peripheral artery disease	$20.00 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	20% coinsurance Service-specific deductible No	Approval required Yes
Air ambulance	20% coinsurance 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	What to know
Medicare-covered dental	$50.00 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
Other dental servicesAdditional plan benefit	$0.00 copay

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0.00 to $50.00 copay Service-specific deductible No	Approval required Yes Referral required No
Medicare-covered eyewear	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$50.00 copay Service-specific deductible No	Approval required Yes Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
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

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 tier	30 days	60 days	100 days
Tier 1Generic	$0.00	$0.00	$0.00
Tier 2Preferred Brand	25%	25%	25%
Tier 3Non-Preferred Drug	35%	35%	35%
Tier 4Injectable Drugs	1%	1%	1%
Tier 5Specialty Tier	25%	Not listed	Not 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 tier	30 days	60 days	100 days
Tier 1Generic	$10.00	$20.00	$30.00
Tier 2Preferred Brand	25%	25%	25%
Tier 3Non-Preferred Drug	36%	36%	36%
Tier 4Injectable Drugs	1%	1%	1%
Tier 5Specialty Tier	25%	Not listed	Not 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 tier	60 days	100 days
Tier 1Generic	$0.00	$0.00
Tier 2Preferred Brand	25%	25%
Tier 3Non-Preferred Drug	35%	35%
Tier 4Injectable Drugs	1%	1%
Tier 6Select Care Drugs	$0.00	$0.00

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier	60 days	100 days
Tier 1Generic	$20.00	$30.00
Tier 2Preferred Brand	25%	25%
Tier 3Non-Preferred Drug	36%	36%
Tier 4Injectable Drugs	1%	1%
Tier 6Select Care Drugs	$0.00	$0.00

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Generic	$10.00
Tier 2Preferred Brand	25%
Tier 3Non-Preferred Drug	36%
Tier 4Injectable Drugs	1%
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 tier	30 days
Tier 1Generic	$10.00
Tier 2Preferred Brand	25%
Tier 3Non-Preferred Drug	36%
Tier 4Injectable Drugs	1%
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 65 county listings across 1 state or territory