Wellcare Low Premium Open (PPO) Medicare Advantage Plan H5439-015 • 2027
- Monthly Premium
- $29.00Plus Part B premium.
- Medical Deductible
- $250
- Maximum Out-of-Pocket
- $9250.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 2,171 beneficiaries
Wellcare Low Premium Open (PPO) Introduction
Wellcare Low Premium Open is a Medicare Advantage PPO plan offered by Wellcare By Health Net. It uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $29.00 monthly premium, $250 medical deductible, and $9250.00 in-network maximum out-of-pocket. CMS Plan ID H5439-015 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
Plan Benefits
Wellcare Low Premium 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 H5439-015.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: 30% coinsurance |
| Specialist | In-network: $55 copay Out-of-network: 30% coinsurance |
In-network: $50 copay Out-of-network: 30% coinsurance |
Preventive and Wellness Services
| 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-$55 copay | In-network: $0-$50 copay |
| Routine chiropractic | Not covered | Not covered |
| 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
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$500 copay Out-of-network: 30% coinsurance |
In-network: $0-$500 copay Out-of-network: 30% coinsurance |
| Lab services | In-network: $0-$50 copay Out-of-network: 30% coinsurance |
In-network: $0-$50 copay Out-of-network: 30% coinsurance |
| Outpatient x-rays | In-network: $50 copay Out-of-network: 30% coinsurance |
In-network: $50 copay Out-of-network: 30% coinsurance |
| Diagnostic tests and procedures | In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
In-network: $0 copay, 20% coinsurance Out-of-network: 30% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $115 copay | $115 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | $40 copay | $40 copay |
| Inpatient hospital care | In-network: Tier 1 $475 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 30% per day for days 1-90 0% per stay |
In-network: Tier 1 $475 per day for days 1-5 $0 per day for days 6-90 $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: $335 copay Out-of-network: $335 copay |
In-network: $350 copay Out-of-network: $350 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $25 copay Out-of-network: 30% coinsurance |
In-network: $25 copay Out-of-network: 30% coinsurance |
| Outpatient group therapy | In-network: $25 copay Out-of-network: 30% coinsurance |
In-network: $25 copay Out-of-network: 30% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $475 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 30% per day for days 1-90 0% per stay |
In-network: Tier 1 $475 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 30% per day for days 1-90 0% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $35 copay Out-of-network: 30% coinsurance |
In-network: $35 copay Out-of-network: 30% coinsurance |
| Occupational therapy | In-network: $35 copay Out-of-network: 30% coinsurance |
In-network: $35 copay Out-of-network: 30% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: 30% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
In-network: 20% coinsurance Out-of-network: 30% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
In-network: 20% coinsurance Out-of-network: 30% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
Dental Services
| 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
| 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
| 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
| 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 Low Premium Open as a Part B benefit.
Prescription Drug Coverage
Wellcare Low Premium 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.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($5.70) |
| Supplemental Part D Premium: | $$5.70 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $6.27 |
| 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 Health Net starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Wellcare Low Premium Open may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 40% coinsurance | Coming soon |
| Injectable Drugs | 1% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5439)
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.
| 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 |
Contact Information for Wellcare By Health Net
- Website
- Wellcare By Health Net Plan Page
- Providers
- Wellcare By Health Net Providers Page
- Formulary
- Wellcare By Health Net Formulary Page
- Pharmacy
- Wellcare By Health Net 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 Low Premium Open (H5439-015-0) is available in the following locations:
Oregon Counties Served
Washington 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 Low Premium Open (PPO)
What is the monthly premium for Wellcare Low Premium Open (PPO)?
The 2027 monthly premium is $29.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan H5439-015?
For 2027, the in-network maximum out-of-pocket is $9250.00. The plan pays 100% of covered in-network services beyond this amount.
What is the CMS star rating for this plan?
CMS rates this plan at ★3.0 out of 5 stars for 2027.
How many beneficiaries are enrolled in this plan?
CMS reports 2,171 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $700.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Wellcare By Health Net (official source) | http://go.wellcare.com/OR | October 4, 2026 |
| Medicare.gov | Understanding 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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