Wellcare Simple Focus (HMO) Medicare Advantage Plan H0562-125 • 2027 • Orange County, CA
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3200.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Orange County, CA
- Local Enrollment
- 1,277 beneficiaries in Orange County
Wellcare Simple Focus (HMO) Introduction
CMS Plan ID H0562-125 identifies Wellcare Simple Focus, a Medicare Advantage HMO plan offered by Wellcare By Health Net. The plan uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $3200.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
This plan is available to eligible beneficiaries who live in Orange County, California. CMS reports local enrollment of 1,277 beneficiaries for this plan in Orange County. New members can contact the plan at (844)480-0680 (TTY 711) for help and additional plan information.
Compare Similar Plans in Orange County
Compare this plan with the two most-enrolled HMO plans available in Orange County, California. Enrollment is based on CMS local enrollment data.
| Plan Detail | Wellcare Simple Focus | SCAN Classic | Kaiser Permanente Senior Advantage LA, Orange Co. |
|---|---|---|---|
| CMS Plan ID | H0562-125-0 |
H5425-007-0 |
H0524-003-0 |
| Local Enrollment | 1,277 | 57,013 | 53,408 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $3,200.00 | $399.00 | $999.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $0 copay | $0 copay | $0 copay |
| Part D Deductible | $700.00 | $370.00 | $0.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $10 copay | $0 copay | $0 copay |
| Vision | Not covered | $0 copay | $0 copay |
| Hearing | Not covered | $0 copay | Not covered |
Plan Benefits
Wellcare Simple Focus has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H0562-125.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H0562-125-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $0 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0-$25 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$50 copay
- Lab services
- In-network: $0-$50 copay
- Outpatient x-rays
- In-network: $25 copay
- Diagnostic tests and procedures
- In-network: $0 copay
Emergency and Urgent Care Services
- Emergency room care
- $150 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0 copay
- Inpatient hospital care
- Tier 1
$230 per day for days 1-5
$0 per day for days 6-90
$0 per stay - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$221 per day for days 21-40
$0 per day for days 41-100 - Ground ambulance
- In-network: $100 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $25 copay
- Outpatient group therapy
- In-network: $25 copay
- Inpatient psychiatric hospital care
- Tier 1
$230 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $0 copay
- Occupational therapy
- In-network: $0 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $10 copay
- Dental x-rays
- In-network: $0-$20 copay
- Cleaning
- In-network: $10 copay
- Periodontics
- In-network: $35-$550 copay
- Endodontics
- In-network: $25-$540 copay
- Restorative services
- In-network: $20-$400 copay
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $35-$250 copay
Vision Services
- Routine eye exam
- Not covered
- Contact lenses
- Not covered
- Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- Not covered
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- Not covered
- Fitting/evaluation
- Not covered
- Prescription hearing aids
- Not covered
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- In-network: $0 copay
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Wellcare Simple Focus as a Part B benefit.
Prescription Drug Coverage
Wellcare Simple Focus includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $7.28 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Wellcare By Health Net starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Wellcare Simple Focus may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 33% coinsurance | Coming soon |
| Injectable Drugs | 15% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H0562)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Wellcare By Health Net
- Website
- Wellcare By Health Net Plan Page
- Providers
- Wellcare By Health Net Providers Page
- Formulary
- Wellcare By Health Net Formulary Page
- Pharmacy
- Wellcare By Health Net Pharmacy Page
- New Member Health Plan Help
- (844)480-0680
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)480-0680
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Wellcare By Health Net (official source) | http://go.wellcare.com/HealthNetCA | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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