Wellcare Low Premium Focus (HMO) Medicare Advantage Plan H0562-012 • 2027 • San Diego County, CA
- Monthly Premium
- $27.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4150.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- San Diego County, CA
- Local Enrollment
- 1,053 beneficiaries in San Diego County
Wellcare Low Premium Focus (HMO) Introduction
This Medicare Advantage HMO plan, Wellcare Low Premium Focus, is offered by Wellcare By Health Net and uses a Health Maintenance Organization (HMO) provider network. It comes with prescription drug coverage. For the 2027 plan year, the monthly premium is $27.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $4150.00. The plan is identified by CMS Plan ID H0562-012. The 2027 Part D prescription drug deductible is $700.00.
Qualifying residents of San Diego County, California may enroll in this plan. CMS enrollment data reports 1,053 plan members in San Diego County. New members can call the plan directly at (844)480-0680 (TTY 711) for assistance.
Compare Similar Plans in San Diego County
Compare this plan with the two most-enrolled HMO plans available in San Diego County, California. Enrollment is based on CMS local enrollment data.
| Plan Detail | Wellcare Low Premium Focus | Kaiser Permanente Senior Advantage San Diego | SCAN Alta |
|---|---|---|---|
| CMS Plan ID | H0562-012-0 |
H0524-037-0 |
H5425-082-0 |
| Local Enrollment | 1,053 | 67,974 | 18,054 |
| Monthly Premium | $27.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $4,150.00 | $3,400.00 | $900.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $5 copay | $15 copay | $0 copay |
| Part D Deductible | $700.00 | $0.00 | $370.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $10 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | Not covered | Not covered | $0 copay |
Plan Benefits
Wellcare Low Premium Focus includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H0562-012.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H0562-012-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $5 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-$250 copay
- Lab services
- In-network: $0-$50 copay
- Outpatient x-rays
- In-network: $0 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
- $25 copay
- Inpatient hospital care
- Tier 1
$375 per day for days 1-6
$0 per day for days 7-90
$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: $250 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $25 copay
- Outpatient group therapy
- In-network: $25 copay
- Inpatient psychiatric hospital care
- Tier 1
$375 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $5 copay
- Occupational therapy
- In-network: $5 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
- In-network: $0 copay
- 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 Low Premium Focus as a Part B benefit.
Prescription Drug Coverage
Wellcare Low Premium 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 Low Premium 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 | 41% coinsurance | Coming soon |
| Injectable Drugs | 1% 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)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, 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 | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
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 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.