Wellcare Simple (HMO)

Wellcare Simple (HMO) is a HMO plan offered by Wellcare of California, Inc. available for the 2026 plan year to people living in Select Counties in CA. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that Wellcare Simple (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about Wellcare Simple (HMO).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The Wellcare Simple (HMO) plan offers an Enhanced Alternative drug benefit with a prescription drug deductible of $615.00. After meeting this deductible, you pay cost-sharing during the initial coverage phase until total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. For a 30-day supply, Tier 1 preferred generics have no copay at preferred pharmacies and a $10.00 copay at standard pharmacies, while Tier 5 specialty drugs have no copay at either. Tier 2 standard generics and Tier 4 non-preferred drugs require a 25% coinsurance at both preferred and standard pharmacies. Tier 3 preferred brands require a 36% coinsurance at preferred pharmacies and 37% coinsurance at standard pharmacies.

Additional Benefits

The Wellcare Simple (HMO) plan offers coverage designed to keep your out-of-pocket costs manageable, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, urgent care, and outpatient therapy services require a low copay of up to $25 with no coinsurance. For inpatient hospital stays, members pay a $425 daily copay for the first 7 days, with no copay required for days 8 through 100. Routine dental, vision, and hearing services are highly accessible with no copay or coinsurance, including allowances for eyewear and hearing aids. Emergency services carry a $130 copay, while diagnostic tests and diabetic supplies are covered with no copay. However, some services like dialysis and durable medical equipment require a 20% coinsurance, and cardiac rehabilitation and over-the-counter items are not covered under this plan.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.