Wellcare Simple Open (PPO) 2026 Plan Details for Bexar County, Texas Residents
Wellcare Simple Open (PPO) 2026 Plan Details for Bexar County, Texas Residents
Choosing the right Medicare Advantage plan in Bexar County is crucial for your healthcare needs in 2026. With Wellcare Simple Open (PPO) as one of the options, you can compare it side-by-side with other available plans to find the best fit for you. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
According to CMS enrollment data, there are approximately 826 members enrolled in this plan, 215 in Bexar County.
Wellcare Simple Open Overview
| Plan ID H7323-007-0 Overview | |
|---|---|
| Health Plan ID: | H7323-007-0 |
| Medicare Advantage Plan Type: | PPO |
| Plan Year: | 2026 |
| 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: | Not offered |
| Part D Drug Plan Benefit: | Enhanced, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Bexar County, TX |
| Insured By: | Wellcare |
Explore the Benefits of Wellcare Simple Open
This MAPD PPO Medicare Advantage plan offers broad coverage with the freedom to choose your providers. With a monthly premium of $0.00, it includes all core benefits under Medicare Part A and Part B, plus prescription drug coverage to manage ongoing medications. The annual Part D deductible is $615.00. You can see any Medicare-approved provider — in or out of network — though in-network care typically costs less.
Primary care visits have a $0 copay | Out-of-network: $35 copay, and specialist visits come with a $30 copay | Out-of-network: $60 copay. Urgent care services carry a $45 copay, and ground ambulance transportation is $245 copay | Out-of-network: $245 copay. These costs all count toward your annual maximum out-of-pocket (MOOP) limit of $5000.00. After that limit is reached, all in-network care is fully covered through the end of the year.
CMS recognizes this plan as H7323-007-0. A detailed breakdown of cost sharing is available below. Still have questions? Check the FAQ section for more insights.
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Cost-Sharing Overview
Wellcare Simple Open 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 H7323-007-0.
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 | Out-of-network: $35 copay |
| Specialist: | In-network: $30 copay | Out-of-network: $60 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: | Not covered |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay | Out-of-network: 75% coinsurance |
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 | $350 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay | Out-of-network: | 30% per day for days 1-90 | 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 | Out-of-network: | 30% per day for days 1-100 | 0% per stay |
| Ground ambulance: | In-network: $245 copay | Out-of-network: $245 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 | Out-of-network: 40% coinsurance |
| Outpatient group therapy: | In-network: $25 copay | Out-of-network: 40% coinsurance |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $350 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay | Out-of-network: | 30% per day for days 1-90 | 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 | Out-of-network: 40% coinsurance |
| Occupational therapy: | In-network: $30 copay | Out-of-network: 40% coinsurance |
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 | Out-of-network: 40% coinsurance |
| Durable medical equipment: | In-network: 20% coinsurance | Out-of-network: 40% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 40% 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-$250 copay | Out-of-network: 40% coinsurance |
| Lab services: | In-network: $0-$50 copay | Out-of-network: 40% coinsurance |
| Outpatient x-rays: | In-network: $25 copay | Out-of-network: 40% coinsurance |
| Diagnostic tests and procedures: | In-network: $0-$10 copay | Out-of-network: 40% coinsurance |
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 | Out-of-network: 0%-40% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 0%-40% 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: 50% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Periodontics: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
| Endodontics: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
| Restorative services: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: 20% coinsurance | Out-of-network: 50% 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 | Out-of-network: 40% coinsurance |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: 40% coinsurance |
| Prescription hearing aids: | In-network: $0 copay | Out-of-network: 40% coinsurance |
| 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 | Out-of-network: 40% coinsurance |
| Contact lenses: | In-network: $0 copay | Out-of-network: 40% coinsurance |
| Eyeglass frames only: | In-network: $0 copay | Out-of-network: 40% coinsurance |
| Eyeglass lenses only: | In-network: $0 copay | Out-of-network: 40% coinsurance |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: 40% coinsurance |
| Upgrades: | In-network: $0 copay | Out-of-network: 40% coinsurance |
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: | Not covered |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | In-network: $0 copay | Out-of-network: $0 copay |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Wellcare Simple Open as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Wellcare Simple Open 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: | $4.82 |
| 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 Open 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 | 36% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Rating Overview
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 |
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 Open?
To enroll in Wellcare Simple Open, 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 Open and benefit from its comprehensive coverage options.
Enrollment Periods for Wellcare Simple Open
Understanding the right time to enroll in Wellcare Simple Open 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 Open
Enrolling in Wellcare Simple Open 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 Open through the official Medicare website.
- Directly with Wellcare Simple Open: 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 H7323-007-0:
Is there a premium for this plan in 2026?
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?
For 2026, the maximum you’d spend out-of-pocket in-network is $5000.00.
Is there a Part D deductible with this plan?
The 2026 drug deductible is $615.00.
How is this plan rated by Medicare?
The latest CMS score is ★3.5 out of 5 stars; anything 4 or higher earns quality bonuses.
Is Wellcare Simple Open popular?
Enrollment stands at roughly 826 members.
Contact Wellcare
| Contact Type | Details |
|---|---|
| Website: | Wellcare Plan Page |
| New Members: | 1-844-480-0680 |
| Existing Members: | 1-833-444-9088 |
| Plan Address: | PO Box 31392 | Tampa, FL 33631 |
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, http://www.wellcare.com/medicare — Last accessed October 13, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage" — Last accessed 25 May, 2025
- Medicare.gov, "Your coverage options" — 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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