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Wellcare Fidelis Simple (HMO-POS) Medicare Advantage Plan H5599-004 • 2027

CMS Rating: ☆☆☆☆☆ (3.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$430
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
11,203 beneficiaries
Last update:

Wellcare Fidelis Simple (HMO-POS) Introduction

This Medicare Advantage HMO-POS plan, Wellcare Fidelis Simple, is offered by Wellcare By Fidelis Care and uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network. It comes with prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $430, and the in-network maximum out-of-pocket is $9850.00. The plan is identified by CMS Plan ID H5599-004. The 2027 Part D prescription drug deductible is $700.00.

Plan Benefits

Wellcare Fidelis 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 H5599-004.

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: $50 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-$50 copay In-network: $0-$40 copay
Routine chiropractic In-network: $15 copay 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 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%-30% coinsurance In-network: 0%-30% coinsurance
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-$85 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 $115 copay $115 copay
Worldwide emergency care Coming soon $115 copay
Urgent care $40 copay $40 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		 In-network:
Tier 1
$600 per day for days 1-4
$0 per day for days 5-90
$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		 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
Ground ambulance In-network: $320 copay In-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 In-network: $35 copay
Outpatient group therapy In-network: $35 copay In-network: $35 copay
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		 In-network:
Tier 1
$600 per day for days 1-4
$0 per day for days 5-90
$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 In-network: $35 copay
Occupational therapy In-network: $35 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 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 In-network: $0 copay
Contact lenses Not covered In-network: $0 copay
Eyeglass frames only Not covered In-network: $0 copay
Eyeglass lenses only Not covered In-network: $0 copay
Eyeglasses (frames & lenses) Not covered In-network: $0 copay
Upgrades Not covered 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 Not covered 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 Fidelis Simple as a Part B benefit.

Prescription Drug Coverage

Wellcare Fidelis 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 Fidelis Simple (H5599-004-0) 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 By Fidelis Care starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Wellcare Fidelis Simple may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Wellcare Fidelis Simple (H5599-004-0) 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 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: H5599)

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 H5599
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 ☆☆☆☆☆

Contact Information for Wellcare By Fidelis Care

Website
Wellcare By Fidelis Care Plan Page
Providers
Wellcare By Fidelis Care Providers Page
Formulary
Wellcare By Fidelis Care Formulary Page
Pharmacy
Wellcare By Fidelis Care 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 Fidelis Simple (H5599-004-0) 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 Fidelis Simple (HMO-POS)

Is there a monthly premium for this plan in 2027?

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

What is the in-network MOOP for plan H5599-004?

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 CMS star rating for this plan?

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

What is the total enrollment for plan H5599-004?

Total enrollment is 11,203 beneficiaries based on the latest CMS data.

Is there a Part D deductible for this plan?

The Part D 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 Fidelis Care (official source) http://www.wellcare.com/fidelisNY October 4, 2026
CMS.gov Medicare Advantage Plan Fact Sheet 25 May, 2025
Medicare.gov Joining a plan 25 May, 2025
Medicare.gov Your 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.