Wellcare Patriot Simple (HMO-POS) Medicare Advantage Plan H4868-003 • 2026 • Erie County, NY

Wellcare Patriot Simple Overview

Coverage Overview for Wellcare Patriot Simple

Wellcare Patriot Simple is a Medicare Advantage HMO-POS plan that includes Medicare Part A and Part B coverage, with limited access to out-of-network providers in certain situations. The monthly premium is $0.00, and costs are generally lower when services are received from in-network providers.

Primary care visits have a $0 copay, specialist visits come with a $20 copay, urgent care services carry a $25 copay, and ambulance transportation is $250 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6700.00. After this limit is reached, in-network services are fully covered.

This plan is listed by CMS under Plan ID H4868-003. A summary of cost sharing is provided below.

Cost-Sharing Overview

Wellcare Patriot Simple has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H4868-003.

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

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

Medicare Plan Star Ratings

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.