Wellcare Simple (HMO-POS) Medicare Advantage Plan H5475-026 • 2027 • Saint Joseph County, MI
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7100.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Saint Joseph County, MI
- Local Enrollment
- 141 beneficiaries in Saint Joseph County
Wellcare Simple (HMO-POS) Introduction
Wellcare Simple is a Medicare Advantage HMO-POS plan offered by Wellcare. It uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $7100.00 in-network maximum out-of-pocket. CMS Plan ID H5475-026 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
You must live in Saint Joseph County, Michigan to enroll in this plan. CMS reports 141 beneficiaries enrolled in this plan in Saint Joseph County. For assistance with this plan, new members can call (844)480-0680 (TTY 711).
Compare Similar Plans in Saint Joseph County
Compare this plan with the two most-enrolled HMO-POS plans available in Saint Joseph County, Michigan. Enrollment is based on CMS local enrollment data.
| Plan Detail | Wellcare Simple | PriorityMedicare Key | BCN Advantage Prime Value |
|---|---|---|---|
| CMS Plan ID | H5475-026-0 |
H2320-022-2 |
H5883-014-2 |
| Local Enrollment | 141 | 1,274 | 98 |
| Monthly Premium | $0.00 | $0.00 | $41.00 |
| Medical Deductible | $0.00 | $375 | $0.00 |
| Maximum Out-of-Pocket | $7,100.00 | $6,950.00 | $6,000.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $45 copay | $0-$40 copay | $35 copay |
| Part D Deductible | $700.00 | $300.00 | $600.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | Not covered |
Plan Benefits
Wellcare Simple 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 H5475-026.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5475-026-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $45 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0-$45 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$500 copay
- Lab services
- In-network: $0-$50 copay
- Outpatient x-rays
- In-network: $50 copay
- Diagnostic tests and procedures
- In-network: $0-$100 copay
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $45 copay
- Inpatient hospital care
- In-network:
Tier 1
$425 per day for days 1-7
$0 per day for days 8-90
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-60
$0 per day for days 61-100 - Ground ambulance
- In-network: $350 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $40 copay
- Outpatient group therapy
- In-network: $40 copay
- Inpatient psychiatric hospital care
- In-network:
Tier 1
$425 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $40 copay
- Occupational therapy
- In-network: $30 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: $0 copay
Out-of-network: 25% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: 25% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: 25% coinsurance - Periodontics
- In-network: $0 copay
Out-of-network: 25% coinsurance - Endodontics
- In-network: $0 copay
Out-of-network: 25% coinsurance - Restorative services
- In-network: $0 copay
Out-of-network: 25% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Out-of-network: 25% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- In-network: $0 copay
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $0 copay
- 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 as a Part B benefit.
Prescription Drug Coverage
Wellcare Simple 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: | ($4.40) |
| Supplemental Part D Premium: | $$4.40 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $6.28 |
| 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 starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Wellcare Simple 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 | 42% 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: H5475)
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 | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Wellcare
- Website
- Wellcare Plan Page
- Providers
- Wellcare Providers Page
- Formulary
- Wellcare Formulary Page
- Pharmacy
- Wellcare 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 (official source) | http://go.wellcare.com/Medicare | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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