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Wellcare Simple (HMO-POS) Medicare Advantage Plan H3499-002 • 2027

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$75
Maximum Out-of-Pocket
$5900.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $700.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
3,887 beneficiaries
Last update:

Wellcare Simple (HMO-POS) Introduction

CMS Plan ID H3499-002 identifies Wellcare Simple, a Medicare Advantage HMO-POS plan offered by Wellcare By Allwell. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $75 medical deductible, and $5900.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.

Plan Benefits

Wellcare Simple 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 H3499-002.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay In-network: $0 copay
Specialist In-network: $35 copay In-network: $25 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 In-network: $0 copay
Telehealth benefit In-network: $0-$45 copay In-network: $0-$45 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits In-network: $0 copay In-network: $0 copay
Health transportation (non-emergency) Coming soon In-network: $0 copay

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$475 copay In-network: $0-$350 copay
Lab services In-network: $0-$50 copay In-network: $0-$50 copay
Outpatient x-rays In-network: $50 copay In-network: $50 copay
Diagnostic tests and procedures In-network: $0-$80 copay In-network: $0-$50 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $130 copay $150 copay
Worldwide emergency care Coming soon $150 copay
Urgent care $35 copay $35 copay
Inpatient hospital care In-network:
Tier 1
$400 per day for days 1-7
$0 per day for days 8-90
$0 per stay		 In-network:
Tier 1
$350 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Skilled Nursing Facility In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-50
$0 per day for days 51-100		 In-network:
Tier 1
$0 per day for days 1-20
$218 per day for days 21-40
$0 per day for days 41-100
Ground ambulance In-network: $350 copay In-network: $300 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $40 copay In-network: $40 copay
Outpatient group therapy In-network: $40 copay In-network: $40 copay
Inpatient psychiatric hospital care In-network:
Tier 1
$400 per day for days 1-7
$0 per day for days 8-90
$0 per stay		 In-network:
Tier 1
$350 per day for days 1-6
$0 per day for days 7-90
$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: $45 copay In-network: $35 copay
Occupational therapy In-network: $45 copay In-network: $35 copay

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 In-network: $0 copay
Durable medical equipment In-network: 20% coinsurance In-network: 20% coinsurance
Prosthetics In-network: 20% coinsurance In-network: 20% 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 In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance In-network: 0%-20% 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: 25% coinsurance		 In-network: $0 copay
Out-of-network: 25% coinsurance
Dental x-rays In-network: $0 copay
Out-of-network: 25% coinsurance		 In-network: $0 copay
Out-of-network: 25% coinsurance
Cleaning In-network: $0 copay
Out-of-network: 25% coinsurance		 In-network: $0 copay
Out-of-network: 25% coinsurance
Periodontics In-network: $0 copay
Out-of-network: 25% coinsurance		 In-network: $0 copay
Out-of-network: 25% coinsurance
Endodontics In-network: $0 copay
Out-of-network: 25% coinsurance		 In-network: $0 copay
Out-of-network: 25% coinsurance
Restorative services In-network: $0 copay
Out-of-network: 25% coinsurance		 In-network: $0 copay
Out-of-network: 25% coinsurance
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: $0 copay
Out-of-network: 25% coinsurance		 In-network: $0 copay
Out-of-network: 25% coinsurance

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay In-network: $0 copay
Contact lenses In-network: $0 copay In-network: $0 copay
Eyeglass frames only In-network: $0 copay In-network: $0 copay
Eyeglass lenses only In-network: $0 copay In-network: $0 copay
Eyeglasses (frames & lenses) In-network: $0 copay In-network: $0 copay
Upgrades In-network: $0 copay In-network: $0 copay

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay In-network: $0 copay
Fitting/evaluation In-network: $0 copay In-network: $0 copay
Prescription hearing aids In-network: $0 copay In-network: $0 copay
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 In-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 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.

Wellcare Simple (H3499-002-0) 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:$17.02
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 Allwell 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.

Wellcare Simple (H3499-002-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Generic$0.00 copayComing soon
Preferred Brand25% coinsuranceComing soon
Non-Preferred Drug47% 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: H3499)

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 H3499
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 ☆☆☆☆☆
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 Allwell

Website
Wellcare By Allwell Plan Page
Providers
Wellcare By Allwell Providers Page
Formulary
Wellcare By Allwell Formulary Page
Pharmacy
Wellcare By Allwell 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.

Plan Availability

Wellcare Simple (H3499-002-0) is available in the following locations:

Indiana 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 (HMO-POS)

How much does plan H3499-002 cost per month?

The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.

What is the annual out-of-pocket maximum (MOOP) for this plan?

The annual in-network MOOP is $5900.00 for 2027. After this limit is reached, covered in-network services are fully paid.

What is the CMS star rating for Wellcare Simple?

The 2027 CMS star rating for Wellcare Simple is ★0.0 out of 5.

What is the current enrollment for Wellcare Simple?

The plan has 3,887 enrolled beneficiaries according to CMS.

What is the prescription drug deductible for 2027?

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 By Allwell (official source) http://go.wellcare.com/IN 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.