Wellcare Patriot Simple (HMO) Medicare Advantage Plan H5294-014 • 2026 • Guadalupe County, TX

Wellcare Patriot Simple Overview

Plan Details for Wellcare Patriot Simple

This Medicare Advantage HMO plan provides Medicare Part A and Part B coverage through a network of participating providers. The monthly premium is $0.00, and services are generally covered when received from in-network providers, except in emergency situations.

Primary care visits have a $0 copay, specialist visits come with a $10 copay, urgent care services carry a $25 copay, and ambulance transportation is $225 copay. These costs apply toward the annual out-of-pocket maximum (MOOP) of $3400.00. Once this limit is reached, in-network services are fully covered for the remainder of the year.

This plan is listed by CMS under Plan ID H5294-014. Cost-sharing details are provided below.

Cost Sharing Expenses

Wellcare Patriot Simple has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5294-014.

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.

Medicare Plan Star Ratings

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.