Wellcare Simple (HMO-POS) 2026 Plan Details for Saint Louis County, Missouri Residents
Wellcare Simple (HMO-POS) 2026 Plan Details for Saint Louis County, Missouri Residents
When selecting a Medicare Advantage plan in Saint Louis County for 2026, it's important to compare all your options. Wellcare Simple (HMO-POS) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
Based on the most recent CMS data, plan enrollments topped 2,183 members, with 269 in Saint Louis County, Missouri.
Wellcare Simple Overview
| Plan ID H1664-001-0 Overview | |
|---|---|
| Health Plan ID: | H1664-001-0 |
| Medicare Advantage Plan Type: | HMO-POS |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $6000.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Enhanced, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Saint Louis County, MO |
| Insured By: | Wellcare by Allwell |
Why Choose Wellcare Simple?
This Medicare Advantage MAPD HMO-POS plan offers both structure and flexibility — including hospital, medical, and prescription drug coverage. With a monthly premium of $0.00, it covers Medicare Part A and Part B benefits, along with built-in drug coverage to help manage ongoing prescriptions. The annual Part D deductible is $615.00. You can get care in or out of network, but you’ll usually pay less when sticking with in-network providers.
Primary care visits have a $0 copay, specialist visits come with a $20 copay, urgent care services carry a $45 copay, and ambulance transportation is $300 copay. These costs apply toward the plan’s maximum out-of-pocket (MOOP) limit of $6000.00. Once that limit is reached, your in-network healthcare is covered at 100% for the rest of the year.
You’ll find this plan listed by CMS as H1664-001-0. A cost-sharing summary appears below with details on what you’ll pay for common services. Still have questions? Check the FAQ section for more answers.
| We're Here to Help You Enroll |
|---|
Out-of-Pocket Expenses
Wellcare Simple has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H1664-001-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $20 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$45 copay |
| Routine chiropractic: | In-network: $15 copay |
| Fitness benefits: | In-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | Not covered |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $130 copay |
| Wordwide emergency care: | $130 copay |
| Urgent care: | $45 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $325 per day for days 1-9 | $0 per day for days 10-90 | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $218 per day for days 21-50 | $0 per day for days 51-100 |
| Ground ambulance: | In-network: $300 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $25 copay |
| Outpatient group therapy: | In-network: $25 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $325 per day for days 1-9 | $0 per day for days 10-90 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $30 copay |
| Occupational therapy: | In-network: $30 copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $0-$300 copay |
| Lab services: | In-network: $0-$50 copay |
| Outpatient x-rays: | In-network: $50 copay |
| Diagnostic tests and procedures: | In-network: $0-$35 copay |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: 25% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: 25% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: 25% coinsurance |
| Periodontics: | In-network: $0 copay | Out-of-network: 25% coinsurance |
| Endodontics: | In-network: $0 copay | Out-of-network: 25% coinsurance |
| Restorative services: | In-network: $0 copay | Out-of-network: 25% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay | Out-of-network: 25% coinsurance |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: $0 copay |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | In-network: $0 copay |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | In-network: $0 copay |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | In-network: $0 copay |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Wellcare Simple as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Wellcare Simple 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: | $0.00 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $43.03 |
| 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 by Allwell starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Wellcare Simple 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 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 34% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
Understanding CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
| 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 | Not enough data available |
| 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Eligibility Requirements for Wellcare Simple
To enroll in Wellcare Simple, you must meet the following criteria:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan’s service area.
If you meet these requirements, you are eligible to enroll in Wellcare Simple and benefit from its comprehensive coverage options.
When Can I Enroll in Wellcare Simple?
Knowing when you can enroll in Wellcare Simple is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Enroll in Wellcare Simple
Joining Wellcare Simple is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join Wellcare Simple.
- Direct Enrollment: You can also choose to enroll directly with Wellcare Simple. The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Here are some of the most frequently asked questions people have about plan ID H1664-001-0:
What’s the monthly premium for Wellcare Simple (HMO-POS)?
The 2026 premium is $0.00 each month, and you must continue to pay your Part B premium.
What is the annual out-of-pocket maximum on this plan?
The annual in-network MOOP is $6000.00, protecting you from larger bills once you hit that limit.
What’s the prescription-drug deductible for 2026?
You’ll pay the first $615.00 in drug costs before coinsurance kicks in.
What’s the CMS star score for Wellcare Simple?
CMS rates it ★3.0 out of 5 stars for 2026.
How many people are enrolled in this plan?
As of last month, about 2,183 beneficiaries are enrolled.
Contact Wellcare by Allwell
| Contact Type | Details |
|---|---|
| Website: | Wellcare by Allwell Plan Page |
| New Members: | 1-844-480-0680 |
| Existing Members: | 1-800-977-7522 |
| Plan Address: | PO Box 10420 | Van Nuys, CA 91410 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Wellcare by Allwell, http://www.wellcare.com/allwellMO — Last accessed October 13, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" — Last accessed 25 May, 2025
Medicare.org is owned and operated by Health Network Group, LLC, an Allstate company. Medicare.org provides information only and is not connected with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content managed by David Bynon, Medicare Analyst.
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