Wellcare Simple (HMO-POS)
Available to residents of Louisa County, IA for 2027. Contract H1862, plan 005, segment 0.
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
Renewed, service area reduced for 2027. CMS carries this plan forward from 2026.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00 |
| In-network out-of-pocket maximum | $4,400.00 |
| Drug deductible | $700.00Tier 1 and 6 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | HMO-POS |
| Contract / plan | H1862-005-0 |
| Offered by | Wellcare |
| Parent organization | Centene Corporation |
| Formulary tiers | 6 |
| Member services | (844)480-0680TTY 711 |
CMS star ratings
- Overall
- 2.5 out of 5 stars for Overall
- Health plan (Part C)
- 2.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 2.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H1862 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Generic | $0.00 |
| Tier 2 · Preferred Brand | 25% |
| Tier 3 · Non-Preferred Drug | 35% |
| Tier 4 · Injectable Drugs | 15% |
| Tier 5 · Specialty Tier | 25% |
| Tier 6 · Select Care Drugs | $0.00 |
Star rating measures
| Measure | 2027 | 2026 |
|---|---|---|
| Staying Healthy: Screenings, Tests and Vaccines | ||
| Breast Cancer Screening · C01 | 1 out of 5 stars for Breast Cancer Screening | 2 out of 5 stars for Breast Cancer Screening |
| Colorectal Cancer Screening · C02 | 2 out of 5 stars for Colorectal Cancer Screening | 3 out of 5 stars for Colorectal Cancer Screening |
| Annual Flu Vaccine · C03 | 1 out of 5 stars for Annual Flu Vaccine | Plan too small to be measured |
| Monitoring Physical Activity · C06 | 1 out of 5 stars for Monitoring Physical Activity | 2 out of 5 stars for Monitoring Physical Activity |
| Managing Chronic (Long Term) Conditions | ||
| Special Needs Plan (SNP) Care Management · C07 | 4 out of 5 stars for Special Needs Plan (SNP) Care Management | no data |
| Care for Older Adults – Medication Review · C08 | 4 out of 5 stars for Care for Older Adults – Medication Review | no data |
| Care for Older Adults - Functional Status Assessment · C09 | 2 out of 5 stars for Care for Older Adults - Functional Status Assessment | new measure |
| Diabetes Care – Eye Exam · C11 | 1 out of 5 stars for Diabetes Care – Eye Exam | 1 out of 5 stars for Diabetes Care – Eye Exam |
| Diabetes Care – Blood Sugar Controlled · C12 | 3 out of 5 stars for Diabetes Care – Blood Sugar Controlled | 3 out of 5 stars for Diabetes Care – Blood Sugar Controlled |
| Kidney Health Evaluation for Patients with Diabetes · C13 | 2 out of 5 stars for Kidney Health Evaluation for Patients with Diabetes | 2 out of 5 stars for Kidney Health Evaluation for Patients with Diabetes |
| Controlling High Blood Pressure · C14 | 2 out of 5 stars for Controlling High Blood Pressure | 2 out of 5 stars for Controlling High Blood Pressure |
| Reducing the Risk of Falling · C15 | 3 out of 5 stars for Reducing the Risk of Falling | 2 out of 5 stars for Reducing the Risk of Falling |
| Improving Bladder Control · C16 | 1 out of 5 stars for Improving Bladder Control | not enough data |
| Statin Therapy for Patients with Cardiovascular Disease · C18 | not enough data | 4 out of 5 stars for Statin Therapy for Patients with Cardiovascular Disease |
| Transitions of Care · C19 | 2 out of 5 stars for Transitions of Care | 3 out of 5 stars for Transitions of Care |
| Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions · C20 | 2 out of 5 stars for Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions | 3 out of 5 stars for Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions |
| Member Experience with Health Plan | ||
| Getting Needed Care · C21 | 3 out of 5 stars for Getting Needed Care | Plan too small to be measured |
| Getting Appointments and Care Quickly · C22 | 4 out of 5 stars for Getting Appointments and Care Quickly | Plan too small to be measured |
| Customer Service · C23 | 1 out of 5 stars for Customer Service | Plan too small to be measured |
| Rating of Health Care Quality · C24 | 1 out of 5 stars for Rating of Health Care Quality | Plan too small to be measured |
| Rating of Health Plan · C25 | 1 out of 5 stars for Rating of Health Plan | Plan too small to be measured |
| Member Complaints and Changes in the Health Plan's Performance | ||
| Complaints about the Health Plan · C27 | 1 out of 5 stars for Complaints about the Health Plan | 4 out of 5 stars for Complaints about the Health Plan |
| Members Choosing to Leave the Plan · C28 | 2 out of 5 stars for Members Choosing to Leave the Plan | not enough data |
| Health Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · C32 | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD1: Drug Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · D01 | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD2: Member Complaints and Changes in the Drug Plan’s Performance | ||
| Complaints about the Drug Plan · D02 | 1 out of 5 stars for Complaints about the Drug Plan | 4 out of 5 stars for Complaints about the Drug Plan |
| Members Choosing to Leave the Plan · D03 | 2 out of 5 stars for Members Choosing to Leave the Plan | not enough data |
| Drug Plan Quality Improvement · D04 | 2 out of 5 stars for Drug Plan Quality Improvement | 3 out of 5 stars for Drug Plan Quality Improvement |
| DD3: Member Experience with the Drug Plan | ||
| Rating of Drug Plan · D05 | 1 out of 5 stars for Rating of Drug Plan | Plan too small to be measured |
| Getting Needed Prescription Drugs · D06 | 4 out of 5 stars for Getting Needed Prescription Drugs | Plan too small to be measured |
| DD4: Drug Safety and Accuracy of Drug Pricing | ||
| MPF Price Accuracy · D07 | 5 out of 5 stars for MPF Price Accuracy | 5 out of 5 stars for MPF Price Accuracy |
| Medication Adherence for Diabetes Medications · D08 | 2 out of 5 stars for Medication Adherence for Diabetes Medications | 3 out of 5 stars for Medication Adherence for Diabetes Medications |
| Medication Adherence for Hypertension (RAS antagonists) · D09 | 2 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) | 3 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) |
| Medication Adherence for Cholesterol (Statins) · D10 | 3 out of 5 stars for Medication Adherence for Cholesterol (Statins) | 4 out of 5 stars for Medication Adherence for Cholesterol (Statins) |
| Statin Use in Persons with Diabetes (SUPD) · D11 | 3 out of 5 stars for Statin Use in Persons with Diabetes (SUPD) | 2 out of 5 stars for Statin Use in Persons with Diabetes (SUPD) |
| Concurrent Use of Opioids and Benzodiazepines (COB) · D12 | 2 out of 5 stars for Concurrent Use of Opioids and Benzodiazepines (COB) | new measure |
| Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) · D13 | 2 out of 5 stars for Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) | new measure |
Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H1862 shares it.
Also available in 75 other IA counties
- Adair
- Adams
- Appanoose
- Audubon
- Benton
- Boone
- Buchanan
- Butler
- Carroll
- Cass
- Cedar
- Cerro Gordo
- Chickasaw
- Clarke
- Clayton
- Clinton
- Crawford
- Dallas
- Davis
- Decatur
- Delaware
- Des Moines
- Floyd
- Franklin
- Fremont
- Greene
- Grundy
- Guthrie
- Hamilton
- Hancock
- Hardin
- Harrison
- Henry
- Howard
- Iowa
- Jackson
- Jasper
- Jefferson
- Johnson
- Jones
- Keokuk
- Kossuth
- Lee
- Linn
- Lucas
- Madison
- Mahaska
- Marion
- Mills
- Mitchell
- Monona
- Monroe
- Montgomery
- Muscatine
- O'Brien
- Osceola
- Page
- Polk
- Pottawattamie
- Poweshiek
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.