Wellcare Simple (HMO-POS)
Available to residents of Lewis County, WA for 2026. Contract H0029, plan 011, segment 0.
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- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
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- Browse the Wellcare Simple (HMO-POS) formulary
Renewed, service area reduced for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $6,500.00? |
| Drug deductible | $615.00Tier 1, 2 and 6 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO-POS? |
| Contract / plan | H0029-011-0 |
| Offered by | Wellcare |
| Parent organization | Centene Corporation |
| Formulary drugs | 3,309 |
| Formulary exception tier | 4? |
| Pharmacy search | go.wellcare.com/Medicare |
| Member services | (844)480-0680TTY 711 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H0029 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $15 copay(authorization required) |
| Other health care professional | $0–$15 copay(authorization required) |
| Additional telehealth services | $0–$50 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | 20% coinsurance |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0–$30 copay(authorization required) |
| Lab services | $0–$50 copay(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | $0–$450 copay(authorization required) |
| Therapeutic radiology | 20% coinsurance(authorization required) |
| Outpatient x-rays | $50 copay(authorization required) |
| Emergency and urgent care | |
| Emergency room | $130 copay |
| Urgent care | $50 copay |
| Worldwide emergency coverage | $130 copay · $50,000 plan limit |
| Worldwide urgent care | $130 copay · $50,000 plan limit |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | $450 per day for days 1–5; $0 per day for days 6–90(authorization required) |
| Outpatient hospital services | $0–$450 copay(authorization required) |
| Outpatient observation | $130–$450 copay |
| Ambulatory surgical center | $225 copay(authorization required) |
| Outpatient blood services | $0 copay |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $218 per day for days 21–50; $0 per day for days 51–100(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | $15 copay(authorization required) |
| Physical therapy and speech-language therapy | $15 copay(authorization required) |
| Cardiac rehabilitation | $40 copay |
| Pulmonary rehabilitation | $35 copay |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $400 per day for days 1–5; $0 per day for days 6–90(authorization required) |
| Outpatient mental health, individual session | $30 copay(authorization required) |
| Outpatient mental health, group session | $30 copay(authorization required) |
| Psychiatrist, individual session | $30 copay(authorization required) |
| Psychiatrist, group session | $30 copay(authorization required) |
| Partial hospitalization | $140 copay(authorization required) |
| Intensive outpatient program | $140 copay(authorization required) |
| Outpatient substance use, individual session | $30 copay(authorization required) |
| Outpatient substance use, group session | $30 copay(authorization required) |
| Opioid treatment program | $15 copay(authorization required) |
| Ambulance and transportation | |
| Ground ambulance | $310 copay(authorization required) |
| Air ambulance | $310 copay(authorization required) |
| Transportation to plan-approved locations | Not covered |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $15 copay(authorization required) |
| Routine chiropractic care | $15 copay(authorization required, limits apply) |
| Acupuncture | $0 copay(authorization required, limits apply) |
| Foot exams and treatment (Medicare-covered) | $15 copay(authorization required) |
| Routine foot care | $15 copay(authorization required, limits apply) |
| Dental? | |
| Medicare-covered dental services | $15 copay(authorization required) |
| Oral exams | $0 copay(authorization required, limits apply) |
| Cleanings | $0 copay(authorization required, limits apply) |
| Fluoride treatment | $0 copay(authorization required, limits apply) |
| Dental x-rays | $0 copay(authorization required, limits apply) |
| Other diagnostic dental services | $0 copay(authorization required, limits apply) |
| Other preventive dental services | $0 copay(authorization required, limits apply) |
| Comprehensive dental plan limit | $1,500 plan limit every year |
| Restorative services (fillings, crowns) | $0 copay(authorization required, limits apply) |
| Endodontics (root canals) | $0 copay(authorization required, limits apply) |
| Periodontics (gum disease) | $0 copay(authorization required, limits apply) |
| Dentures and other removable prosthodontics | $0 copay(authorization required, limits apply) |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | $0 copay(authorization required, limits apply) |
| Oral and maxillofacial surgery | $0 copay(authorization required, limits apply) |
| Orthodontics | Not covered |
| Adjunctive general services | $0 copay(authorization required, limits apply) |
| Vision? | |
| Eye exam (Medicare-covered) | $0–$15 copay(authorization required) |
| Routine eye exam | $0 copay(authorization required, limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(authorization required, limits apply) |
| Eyewear plan limit | $200 plan limit every year |
| Contact lenses | $0 copay(authorization required, limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(authorization required, limits apply) |
| Eyeglass lenses | $0 copay(authorization required, limits apply) |
| Eyeglass frames | $0 copay(authorization required, limits apply) |
| Eyewear upgrades | $0 copay(authorization required, limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | $15 copay(authorization required) |
| Routine hearing exam | $0 copay(authorization required, limits apply) |
| Hearing aid fitting and evaluation | $0 copay(authorization required, limits apply) |
| Hearing aid plan limit | $1,000 plan limit every year |
| Hearing aids (all types) | $0 copay(authorization required, limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $35 copay(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Covered (allowance not stated) |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | $0 copay |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $0.00 |
| Tier 3 | 25% |
| Tier 4 | 35% |
| Tier 5 | 25% |
| Tier 6 | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $5.00 | n/a | $0.00 | $15.00 | $0.00 |
| Tier 2: Generic | $0.00 | $10.00 | n/a | $0.00 | $30.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $5.00 | n/a | $0.00 | $15.00 | $0.00 |
| Tier 2: Generic | $0.00 | $10.00 | n/a | $0.00 | $30.00 | $0.00 |
| Tier 3: Preferred Brand | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 35% | 36% | n/a | 35% | 36% | 35% |
| Tier 5: Specialty Tier | 25% | 25% | n/a | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 31 other WA counties
Benefits in plain text
Wellcare Simple (HMO-POS) (H0029-011-0) is a 2026 HMO-POS Medicare Advantage plan offered by Wellcare, available to residents of Lewis County, WA.
The monthly premium is $0.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $6,500.00.
The drug deductible is $615.00. Tier 1, 2 and 6 exempt.
The plan's formulary lists 3,309 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $0.00; tier 3: 25%; tier 4: 35%; tier 5: 25%; tier 6: $0.00.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.