Wellcare Low Premium Open (PPO)

Wellcare Low Premium Open (PPO), plan H5439-015-000, is a 2027 Medicare Advantage plan from Wellcare, sold in Washington. Its in-network out-of-pocket limit for the year is $9,250.

This is a PPO, so it pays toward care both inside and outside its network. In-network care costs you less, and an out-of-network provider has to accept Medicare and agree to bill the plan. The plan's Summary of Benefits lists an out-of-network amount for each service next to the in-network one, and that is the column to read before you book a visit outside the network.

To join, you need Medicare Part A and Part B and you have to live in the plan's service area, which covers 9 counties in Washington for 2027. You keep paying your Part B premium to Medicare.

Counties in the service area include Clackamas, Lane, Linn, Marion, Multnomah and Polk.

In network, a primary care visit is $0, a specialist visit is $55, the emergency room is $115 and urgent care is $40. Emergency care and urgently needed services are covered whether or not the provider is in the plan's network, which matters when you are away from home.

An individual mental health visit is $25 and occupational therapy is $35.

Physical therapy and speech therapy are covered too, at cost shares the plan lists in its Summary of Benefits rather than in the CMS benefit files, so check those two there.

You pay $0 for the preventive services Original Medicare covers when you use a provider in the plan's network. That includes your annual wellness visit, the recommended screenings for your age, and most vaccines. Preventive care is the easiest value to collect from any Medicare Advantage plan, so book the wellness visit early in the year.

Beyond what Original Medicare covers, this plan includes $350 toward hearing aids. These allowances almost always have to be used with providers and suppliers the plan works with, so check that before you buy, particularly for hearing aids where the plan usually names its own vendor.

Part D prescription drug coverage is included, so you do not need a separate drug plan. Check the plan's formulary, which is its list of covered drugs, for every medicine you take before you enroll.

For 2027, the drug deductible is $700 and your own drug costs are capped at $2,400 for the year.

The plan sorts drugs into 6 tiers, and what you pay depends on the tier and on which pharmacy you use. The tier table below shows the cost at a preferred retail pharmacy, a standard retail pharmacy, and by mail. Because drug coverage is built in, you do not add a standalone prescription drug plan on top.

If a medicine you take is not on the formulary, your prescriber can ask the plan for an exception, and if your income is limited, Extra Help can cut what you pay for drugs regardless of which plan you choose.

Some care on this plan needs prior authorization, which means Wellcare has to approve it before you get it. Specialist services are among those that do. Your doctor's office usually files the request, but the plan may not pay if the approval is skipped, so confirm it is in hand before a scheduled procedure. The plan's evidence of coverage lists every service that needs it.

Here is how Wellcare Low Premium Open (PPO) sits against other plans sold in Clark County for 2027.

UHC Care Advantage WA-E001 (PPO I-SNP) has a lower in-network limit at $4,000. UHC Care Advantage WA-E001 (PPO I-SNP) rates higher at 5 stars.

This plan may fit people in the service area who are comfortable with a $9,250 ceiling on in-network costs. Because it is a PPO, you also keep some coverage outside the network, at a higher cost.

Like any Medicare Advantage plan, it changes how your Medicare claims are paid. If you travel often, or you want to use any doctor who accepts Medicare without checking a network, compare it against Original Medicare with a Medicare Supplement and a separate drug plan before you decide.

A licensed insurance agent can check all of these against your own doctors and prescriptions at no cost.