Wellcare Simple Value (HMO)

by Wellcare

2027 Medicare Advantage plan available in Texas

Plan ID H5294-026-0

Additional coverage:

RxDental

Medicare Advantage HMO $0 premium

Monthly plan premium $0 / mo

Annual deductible $0 / yr

Max out-of-pocket · in-network $9,850 / yr

Drug deductible $700 / yr

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Plan Overview

Wellcare Simple Value (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Texas and offered by the health insurance company Wellcare. This plan's network type is HMO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name Wellcare Simple Value (HMO)

Insurance Carrier Wellcare

Plan Type Medicare Advantage Plan With Part D Prescription Drug Coverage

Network Type HMO

Cost Summary

Wellcare Simple Value (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $9,850. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $0 / mo

Health portion of premium $0

Drug portion of premium $0

Annual Deductible $0 / yr

Max Out-of-Pocket · in-network $9,850 / yr

Primary doctor visit $0 copay

Specialist visit $50 copay

ER visit $115 copay

Ambulance 20% coinsurance

Additional Benefits and Coverage

Wellcare Simple Value (HMO) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Wellcare Simple Value (HMO) includes coverage for dental.

Part D Prescription Drug Coverage Yes

Dental Yes

Vision No

Hearing No

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Not covered

In-home support services Not covered

Home & bathroom safety devices Not covered

Meals for short duration Not covered

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: $0 copay
Out-of-network: $0 copay

Specialist visit In-network: $50 copay
Out-of-network: $50 copay

Tests, labs & imaging

Diagnostic tests & procedures In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Lab services In-network: $0-$50 copay
Out-of-network: $0-$50 copay

Diagnostic radiology services (like MRI) In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Outpatient x-rays In-network: $50 copay
Out-of-network: $50 copay

Emergency care $115 copay

Urgent care $40 copay

Hospital Services

Inpatient hospital coverage Tier 1
$425 per day for days 1-4
$0 per day for days 5-90
$0 per stay

Outpatient hospital coverage In-network: 0%-30% coinsurance
Out-of-network: 0%-30% coinsurance

Skilled nursing facility

Skilled nursing facility Tier 1
$0 per day for days 1-20
$221 per day for days 21-70
$0 per day for days 71-100

Preventive services

Preventive services In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Therapy services

Occupational therapy visit In-network: $25 copay
Out-of-network: $25 copay

Physical therapy & speech & language therapy visit In-network: $25 copay
Out-of-network: $25 copay

Mental health services

Outpatient group therapy with a psychiatrist In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Outpatient individual therapy with a psychiatrist In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Outpatient group therapy visit In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Outpatient individual therapy visit In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Diabetes supplies In-network: $0 copay
Out-of-network: $0 copay

Prescription drugs (Part D benefits)

Drug tier standard retail · 1-month supply Initial coverage Catastrophic

Preferred Generic

Generic $10.00 copay $0 copay

Preferred Brand 25% coinsurance $0 copay

Non-Preferred Drug 36% coinsurance $0 copay

Specialty Tier 25% coinsurance $0 copay

Part B drugs

Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Extra Benefits

Hearing

Hearing exam Not covered

Fitting/evaluation Not covered

Hearing aids - prescription Not covered

Hearing aids - over the counter Not covered

Preventive dental

Oral exam In-network: $0 copay
Out-of-network: $0 copay

Cleaning In-network: $0 copay
Out-of-network: $0 copay

Fluoride treatment In-network: $0 copay
Out-of-network: $0 copay

Dental x-rays In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services Not covered

Endodontics Not covered

Periodontics Not covered

Prosthodontics, removable Not covered

Prosthodontics, fixed Not covered

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery Not covered

Orthodontics Not covered

Adjunctive general services In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam Not covered

Contact lenses Not covered

Eyeglasses (frames & lenses) Not covered

Eyeglass frames (only) Not covered

Eyeglass lenses (only) Not covered

Upgrades Not covered

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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