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Wellcare Simple Open (PPO) Medicare Advantage Plan H7518-001 • 2027 • Miller County, MO

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$360
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
Miller County, MO
Local Enrollment
16 beneficiaries in Miller County
Last update:

Wellcare Simple Open (PPO) Introduction

CMS Plan ID H7518-001 identifies Wellcare Simple Open, a Medicare Advantage PPO plan offered by Wellcare. The plan uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $360 medical deductible, and $7100.00 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 Miller County, Missouri. CMS reports local enrollment of 16 beneficiaries for this plan in Miller County. New members can contact the plan at (844)480-0680 (TTY 711) for help and additional plan information.

Compare Similar Plans in Miller County

Compare this plan with the two most-enrolled PPO plans available in Miller County, Missouri. Enrollment is based on CMS local enrollment data.

PPO plan comparison for Miller County, Missouri
Plan Detail Wellcare Simple Open Humana Value Choice Humana Value Choice
CMS Plan ID H7518-001-0 H7617-023-0 H5216-318-1
Local Enrollment 16 508 229
Monthly Premium $0.00 $0.00 $0.00
Medical Deductible $360 $750 $650
Maximum Out-of-Pocket $7,100.00 $4,400.00 $4,450.00
Part B Giveback Not offered Not offered Not offered
Primary Care $0 copay $0 copay $0 copay
Specialist $20 copay $30 copay $30 copay
Part D Deductible $700.00 $700.00 $700.00
CMS Star Rating Not yet rated Not yet rated Not yet rated
Dental $0 copay $0 copay $0 copay
Vision Not covered $0 copay $0 copay
Hearing Not covered $0 copay $0 copay

Plan Benefits

Wellcare Simple Open 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 H7518-001.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H7518-001-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Out-of-network: $25 copay
Specialist
In-network: $20 copay
Out-of-network: $35 copay

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Out-of-network: $0 copay
Telehealth benefit
In-network: $0-$25 copay
Routine chiropractic
In-network: $15 copay
Out-of-network: 40% coinsurance
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-$325 copay
Out-of-network: 40% coinsurance
Lab services
In-network: $0-$50 copay
Out-of-network: 40% coinsurance
Outpatient x-rays
In-network: $50 copay
Out-of-network: 40% coinsurance
Diagnostic tests and procedures
In-network: $0-$50 copay
Out-of-network: 40% coinsurance

Emergency and Urgent Care Services

Emergency room care
$130 copay
Worldwide emergency care
Coming soon
Urgent care
$25 copay
Inpatient hospital care
In-network:
Tier 1
$425 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
30% per day for days 1-90
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
Out-of-network:
30% per day for days 1-100
0% per stay
Ground ambulance
In-network: $300 copay
Out-of-network: $300 copay

Mental Health Services

Outpatient individual therapy
In-network: $25 copay
Out-of-network: 40% coinsurance
Outpatient group therapy
In-network: $25 copay
Out-of-network: 40% coinsurance
Inpatient psychiatric hospital care
In-network:
Tier 1
$425 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
30% per day for days 1-90
0% per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $10 copay
Out-of-network: 40% coinsurance
Occupational therapy
In-network: $10 copay
Out-of-network: 40% coinsurance

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Out-of-network: 40% coinsurance
Durable medical equipment
In-network: 20% coinsurance
Out-of-network: 40% coinsurance
Prosthetics
In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance

Dental Services

Oral exam
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: 50% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 50% coinsurance
Periodontics
Not covered
Endodontics
Not covered
Restorative services
Not covered
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
Not covered

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
Out-of-network: $0 copay
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by Wellcare Simple Open as a Part B benefit.

Prescription Drug Coverage

Wellcare Simple Open 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.

Wellcare Simple Open (H7518-001-0) Prescription Drug Plan Premium Details
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:$18.38
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 Open may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Wellcare Simple Open (H7518-001-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Generic$0.00 copayComing soon
Preferred Brand25% coinsuranceComing soon
Non-Preferred Drug48% coinsuranceComing soon
Injectable Drugs1% coinsuranceComing soon
Specialty Tier25% coinsuranceComing soon
Select Care Drugs$0.00 copayComing soon
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H7518)

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.

2027 Medicare Star Ratings for Contract H7518
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 Not enough data available
Drug Plan Customer Service Not enough data available
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan Not enough data available
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
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.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Wellcare (official source) http://go.wellcare.com/Medicare October 4, 2026
Medicare.gov Compare types of Medicare Advantage Plans 25 May, 2025
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You 25 May, 2025
Medicare.gov Compare Original Medicare & Medicare Advantage 25 May, 2025

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.