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Wellcare Simple Open (PPO) Medicare Advantage Plan H2775-106 • 2027

CMS Rating: ☆☆☆☆☆ (3.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$300
Maximum Out-of-Pocket
$9850.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $700.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
21,870 beneficiaries
Last update:

Wellcare Simple Open (PPO) Introduction

Wellcare Simple Open is a Medicare Advantage PPO plan offered by Wellcare. It uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $300 medical deductible, and $9850.00 in-network maximum out-of-pocket. CMS Plan ID H2775-106 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.

Plan Benefits

Cost-sharing for Wellcare Simple Open includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H2775-106.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay
Out-of-network: $25 copay		 In-network: $0 copay
Out-of-network: $25 copay
Specialist In-network: $50 copay
Out-of-network: $60 copay		 In-network: $30 copay
Out-of-network: $60 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Telehealth benefit In-network: $0-$50 copay In-network: $0-$35 copay
Routine chiropractic In-network: $15 copay
Out-of-network: 40% coinsurance		 In-network: $15 copay
Out-of-network: 40% coinsurance
Fitness benefits Coming soon In-network: $0 copay
Out-of-network: $0 copay
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits Not covered Not covered
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$500 copay
Out-of-network: 40% coinsurance		 In-network: $0-$500 copay
Out-of-network: 40% coinsurance
Lab services In-network: $0-$50 copay
Out-of-network: 40% coinsurance		 In-network: $0-$50 copay
Out-of-network: 40% coinsurance
Outpatient x-rays In-network: $50 copay
Out-of-network: 40% coinsurance		 In-network: $50 copay
Out-of-network: 40% coinsurance
Diagnostic tests and procedures In-network: $0-$75 copay
Out-of-network: 40% coinsurance		 In-network: $0-$75 copay
Out-of-network: 40% coinsurance

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $115 copay $115 copay
Worldwide emergency care Coming soon $115 copay
Urgent care $35 copay $35 copay
Inpatient hospital care In-network:
Tier 1
$600 per day for days 1-4
$0 per day for days 5-90
$0 per stay
Out-of-network:
30% per day for days 1-90
0% per stay		 In-network:
Tier 1
$600 per day for days 1-4
$0 per day for days 5-90
$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 21-70
$0 per day for days 71-100
Out-of-network:
30% per day for days 1-100
0% per stay		 In-network:
Tier 1
$0 per day for days 1-20
$218 per day for days 21-70
$0 per day for days 71-100
Out-of-network:
30% per day for days 1-100
0% per stay
Ground ambulance In-network: $340 copay
Out-of-network: $340 copay		 In-network: $350 copay
Out-of-network: $350 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $35 copay
Out-of-network: 40% coinsurance		 In-network: $35 copay
Out-of-network: 40% coinsurance
Outpatient group therapy In-network: $35 copay
Out-of-network: 40% coinsurance		 In-network: $35 copay
Out-of-network: 40% coinsurance
Inpatient psychiatric hospital care In-network:
Tier 1
$600 per day for days 1-4
$0 per day for days 5-90
$0 per stay
Out-of-network:
30% per day for days 1-90
0% per stay		 In-network:
Tier 1
$600 per day for days 1-4
$0 per day for days 5-90
$0 per stay
Out-of-network:
30% per day for days 1-90
0% per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $35 copay
Out-of-network: 40% coinsurance		 In-network: $35 copay
Out-of-network: 40% coinsurance
Occupational therapy In-network: $35 copay
Out-of-network: 40% coinsurance		 In-network: $35 copay
Out-of-network: 40% coinsurance

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Durable medical equipment In-network: 20% coinsurance
Out-of-network: 40% coinsurance		 In-network: 20% coinsurance
Out-of-network: 40% coinsurance
Prosthetics In-network: 20% coinsurance
Out-of-network: 40% coinsurance		 In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance		 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		 In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Periodontics Not covered Not covered
Endodontics Not covered Not covered
Restorative services Not covered Not covered
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery Not covered Not covered

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Contact lenses Not covered In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglass frames only Not covered In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglass lenses only Not covered In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglasses (frames & lenses) Not covered In-network: $0 copay
Out-of-network: 40% coinsurance
Upgrades Not covered In-network: $0 copay
Out-of-network: 40% coinsurance

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Fitting/evaluation In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Prescription hearing aids In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
OTC hearing aids Not covered Not covered

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered 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 (H2775-106-0) 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:$40.45
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 (H2775-106-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Generic$0.00 copayComing soon
Preferred Brand25% coinsuranceComing soon
Non-Preferred Drug37% coinsuranceComing soon
Injectable Drugs15% coinsuranceComing soon
Specialty Tier25% coinsuranceComing soon
Select Care Drugs$0.00 copayComing soon
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H2775)

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.

2027 Medicare Star Ratings for Contract H2775
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 ☆☆☆☆☆

Plan Availability

Wellcare Simple Open (H2775-106-0) is available in the following locations:

New York Counties Served

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About Wellcare Simple Open (PPO)

How much does plan H2775-106 cost per month?

The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.

What is the in-network MOOP for plan H2775-106?

For 2027, the in-network maximum out-of-pocket is $9850.00. The plan pays 100% of covered in-network services beyond this amount.

What is the star rating for plan H2775-106 in 2027?

CMS rates this plan at ★3.0 out of 5 stars for 2027.

What is the current enrollment for Wellcare Simple Open?

Total enrollment is 21,870 beneficiaries based on the latest CMS data.

What is the Part D deductible for plan H2775-106?

For 2027, the prescription drug deductible is $700.00.

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://www.wellcare.com/medicare October 4, 2026
CMS.gov Medicare Advantage Plan Fact Sheet 25 May, 2025
Medicare.gov Joining a plan 25 May, 2025
Medicare.gov Explore your Medicare 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.