Wellcare Simple (HMO-POS) (HMO-POS) 2025 Plan Details for Wexford County, Michigan Residents
Wellcare Simple (HMO-POS) (HMO-POS) 2025 Plan Details for Wexford County, Michigan Residents
Wellcare Simple (HMO-POS) is a HMO-POS Medicare Advantage plan, from Wellcare, {with_without_pdp} a prescription drug plan. It's CMS Plan ID is: H5475-026-0. It is not available in all areas. The list of locations where this plan is available can be found below.
According to CMS enrollment data (July, 2025), there are approximately 8,307 members enrolled in this plan.
Wellcare Simple (HMO-POS) (HMO-POS) Overview
| CMS Fact | Landscape Value |
|---|---|
| Health Plan ID: | H5475-026-0 |
| CMS Overall Rating: | 0.0 out of 5 stars* |
| Medicare Advantage Plan Type: | HMO-POS |
| Coverage Year: | CY2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $5000.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Wexford County, MI |
| Insured By: | Wellcare |
| Last Plan Content Update: |
Plan Availability by Location
Health Plan Out-of-Pocket Costs
Prescription Drug Costs & Benefits
Wellcare Simple (HMO-POS) includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $($26.10) |
|---|---|
| Supplemental Part D Premium: | $$26.10 |
| Total Part D Premium: | $$0.00 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| 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 $615.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Wellcare starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Wellcare Simple (HMO-POS) may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $5.00 |
| Generic* | $0.00 | $10.00 |
| Preferred Brand | 25.00% | 25.00% |
| Non-Preferred Drug | 44.00% | 45.00% |
| Specialty Tier | 28.00% | 28.00% |
| Select Care Drugs* | $0.00 | $0.00 |
| *Deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
Need Help Enrolling?
| Website: | Wellcare Plan Page |
|---|---|
| Providers: | Wellcare Providers Page |
| Formulary: | Wellcare Formulary Page |
| Pharmacy: | Wellcare Pharmacy Page |
| New Member Health Plan Help: | (800)225-8017 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)270-5320 |
| New Member Part D TTY Users: | 711 |
Frequently Asked Questions
📘 What does Medicare plan code H5475 026 mean?
Wellcare Simple (HMO-POS) is a Medicare Advantage plan by Wellcare. The code H5475 is the CMS contract ID, whereas 026 is its plan ID.
- Plan Name: Wellcare Simple (HMO-POS)
- Plan Type: HMO-POS
- Premium: $0.00/mo + your monthly Part B premium
- Out-of-Pocket Max: $5000.00 (in-network)
- Drug Coverage: {pdp_faq_summary}
- CMS Star Rating: 0.0 out of 5
- Contract Year: 2026
This information is based on official CMS data and is provided for educational purposes. Always review your plan’s official documents or contact the provider directly before making enrollment decisions.
📋 What type of plan is H5475 026?
This plan is a HMO-POS — specifically, it's an HMO-POS plan with a Medicare Advantage contract that's offered by Wellcare. It comes with defined provider network rules you should be aware of.
- Plan Marketing Name: Wellcare Simple (HMO-POS)
- Network Type: {plan_type_expanded}
- Referral Requirement: {referral_required_expanded}
- Prescription Coverage: {pdp_faq_summary}
Plan types like HMOs and PPOs determine whether you can go out-of-network or need referrals to see specialists.
📦 What benefits are included in H5475 026?
This plan covers all Medicare Part A and Part B services. Depending on the plan, it may also include valuable extras like dental, vision, and hearing benefits.
- Medical Services: Hospital, doctor visits, preventive care
- Prescription Drugs: Enhanced, $615.00 deductible
- Dental: {dental_benefit}
- Vision: {vision_benefit}
- Hearing: {hearing_benefit}
Benefit availability may vary by location and plan version. Confirm specific details in your plan's Evidence of Coverage (EOC).