Wellcare Simple (HMO-POS) H4661-001-0 Plan Details
Wellcare Simple (HMO-POS) H4661-001-0 Plan Details
Navigating your Medicare Advantage options for 2025 can be overwhelming, but we're here to help. With Wellcare Simple (HMO-POS) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
Based on May, 2025 CMS enrollment data, an estimated 430 Medicare beneficiaries are enrolled in this plan.
Wellcare Simple Overview
| Plan ID H4661-001-0 Overview | |
|---|---|
| Health Plan ID: | H4661-001-0 |
| Medicare Advantage Plan Type: | HMO-POS |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $6,000.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $420.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | See List |
| Insured By: | Wellcare |
Plan Availability
Wellcare Simple (H4661-001-0) is available in the following locations (click to open):
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 $420.00. 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 $25 copay, urgent care services carry a $25 copay, and ambulance transportation is $305 copay. These costs apply toward the plan’s maximum out-of-pocket (MOOP) limit of $6,000.00 . 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 H4661-001-0. 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.
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Cost-Sharing Overview
Wellcare Simple includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H4661-001-0.
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: | $0 Copay |
| Specialist: | $25 Copay Prior Authorization Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $125 Copay |
| Urgent care: | $25 Copay |
| Ground ambulance: | $305 Copay |
| Inpatient hospital care: | $300.00 per day for days 1 through 9 $0.00 per day for days 10 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $214.00 per day for days 21 through 70 $0.00 per day for days 71 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $25 Copay Prior Authorization Required |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $20 Copay Prior Authorization Required |
| Routine chiropractic: | Not Covered |
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: | $25 Copay |
| Outpatient group therapy: | $25 Copay |
| Inpatient psychiatric hospital care: | $1,875.00 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: | $30 Copay Prior Authorization Required |
| Occupational therapy: | $30 Copay Prior Authorization Required |
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: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 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: | $300 Copay Prior Authorization Required |
| Lab services: | $50 Copay Prior Authorization Required |
| Outpatient x-rays: | $100 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $75 Copay Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 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) |
|---|---|
| Medicare Covered Preventive Dental | $25 Copay Prior Authorization Required |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay Prior Authorization Required |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay Prior Authorization Required |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 to $25 Copay |
| Routine eye exam (in-network) | $0 Copay Prior Authorization Required, 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $200.00 Every year |
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: | $(8.20) |
|---|---|
| Supplemental Part D Premium: | $8.20 |
| 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 $420.00 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 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 | 36.00% | 36.00% |
| Specialty Tier | 28.00% | 28.00% |
| Select Care Drugs* | $0.00 | $0.00 |
| *Deductible does not apply. | ||
How CMS Star Ratings Guide Your Choice
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 |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in Wellcare Simple ?
To qualify for enrollment in Wellcare Simple , you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
If you fulfill these criteria, you can enroll in Wellcare Simple and enjoy the extensive healthcare benefits it offers.
When Should You Enroll in Wellcare Simple ?
Understanding the right time to enroll in Wellcare Simple is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
Steps to Enroll in Wellcare Simple
Enrolling in Wellcare Simple is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Wellcare Simple through the official Medicare website.
- Directly with Wellcare Simple : You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Here are some of the most frequently asked questions people have about plan ID H4661-001-0:
How much does H4661-001-0 cost per month?
For 2025, the monthly premium is $0.00, and you still pay your Part B premium to Medicare.
What is the annual out-of-pocket maximum on this plan?
For 2025, the maximum you’d spend out-of-pocket in-network is $6,000.00 .
What’s the prescription-drug deductible for 2025?
The 2025 drug deductible is $420.00. The plan has at least one drug tier with no deductible.
How is this plan rated by Medicare?
CMS rates it ★0.0 out of 5 stars for 2025.
How many members does Wellcare Simple have?
CMS reports 430 members in the latest file.
Contact Wellcare
| 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 |
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.
- Wellcare, http://www.wellcare.com/DE, Last Accessed June 1, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet", Last Accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage", Last Accessed 25 May, 2025
- Medicare.gov, "Explore your Medicare coverage options", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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