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Wellcare Patriot Simple (HMO) Medicare Advantage Plan H5294-014 • 2027

CMS Rating: ☆☆☆☆☆ (3.5 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$3400.00In-network
Part B Giveback
Not offered
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
193 beneficiaries
Last update:

Wellcare Patriot Simple (HMO) Introduction

This Medicare Advantage HMO plan, Wellcare Patriot Simple, is offered by Wellcare By Allwell and uses a Health Maintenance Organization (HMO) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $3400.00. The plan is identified by CMS Plan ID H5294-014.

Plan Benefits

Wellcare Patriot 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 H5294-014.

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: $10 copay In-network: $10 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-$25 copay In-network: $0-$25 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 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-$200 copay In-network: $0-$200 copay
Lab services In-network: $0-$50 copay In-network: $0-$50 copay
Outpatient x-rays In-network: $25 copay In-network: $25 copay
Diagnostic tests and procedures In-network: $0 copay In-network: $0 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 $150 copay $150 copay
Worldwide emergency care Coming soon $150 copay
Urgent care $25 copay $25 copay
Inpatient hospital care Tier 1
$275 per day for days 1-5
$0 per day for days 6-90
$0 per stay		 Tier 1
$275 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Skilled Nursing Facility Tier 1
$0 per day for days 1-20
$221 per day for days 21-40
$0 per day for days 41-100		 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: $225 copay In-network: $225 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $0 copay In-network: $0 copay
Outpatient group therapy In-network: $0 copay In-network: $0 copay
Inpatient psychiatric hospital care Tier 1
$275 per day for days 1-5
$0 per day for days 6-90
$0 per stay		 Tier 1
$275 per day for days 1-5
$0 per day for days 6-90
$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: $10 copay In-network: $10 copay
Occupational therapy In-network: $10 copay In-network: $10 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 In-network: $0 copay
Dental x-rays In-network: $0 copay In-network: $0 copay
Cleaning In-network: $0 copay In-network: $0 copay
Periodontics In-network: $0 copay In-network: $0 copay
Endodontics In-network: $0 copay In-network: $0 copay
Restorative services In-network: $0 copay In-network: $0 copay
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: $0 copay In-network: $0 copay

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 In-network: $0 copay
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 Patriot Simple as a Part B benefit.

Prescription Drug Coverage

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

CMS 5-Star Performance Ratings (Contract ID: H5294)

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.

2027 Medicare Star Ratings for Contract H5294
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 ☆☆☆☆☆

Plan Availability

Wellcare Patriot Simple (H5294-014-0) is available in the following locations:

Texas 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 Patriot Simple (HMO)

What is the monthly premium for Wellcare Patriot Simple (HMO)?

For 2027, the monthly premium is $0.00. Medicare Part B premiums apply in addition to this amount.

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

For 2027, the in-network maximum out-of-pocket is $3400.00. The plan pays 100% of covered in-network services beyond this amount.

What is the current enrollment for Wellcare Patriot Simple?

The plan has 193 enrolled beneficiaries according to CMS.

Is there a Part D deductible for this plan?

The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.

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://www.wellcare.com/allwellTX October 4, 2026
Medicare.gov Understanding Medicare Advantage Plans 25 May, 2025
AARP.org The Big Choice: Original Medicare vs. Medicare Advantage 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.