Wellcare Fidelis Patriot Simple (HMO-POS)

NEW YORK QUALITY HEALTHCARE CORPORATION · 2027 plan year

Plan ID H5599-010-000

HMOPOS★ 3 CMS Stars
MOOP (in-network)
$9,850
MOOP (combined)
—
Monthly premium
$0/mo
Prescription drugs
Not included

This plan in 2026

Plan information

Contract / Plan / Segment
H5599-010-000
Medical deductible
$0 — no deductible
Also owed
Your Medicare Part B premium, paid separately

More NEW YORK QUALITY HEALTHCARE CORPORATION plans in NY

Benefits & cost sharing

Primary Care

BenefitIn-network
Chiropractic — Routine Care$15

Hospital

BenefitIn-network
Worldwide Urgent Care Coverage$115
Inpatient Hospital — Acute$400/day for days 1–5, $0 after
Inpatient Hospital — Psychiatric$350 per stay

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Supplemental Health BenefitsSee plan details
Mental Health Specialty ServicesSee plan details
Mental Health — Individual SessionsNo charge
Mental Health — Group SessionsNo charge

Other

BenefitIn-network
Skilled Nursing Facility (SNF)$0/day for days 1–20, $221/day for days 21–70, $0 after
Cardiac & Pulmonary RehabilitationSee plan details
Cardiac Rehabilitation — Additional Sessions$30
Intensive Cardiac Rehabilitation — Additional Sessions$40
Pulmonary Rehabilitation — Additional Sessions$25
Supervised Exercise Therapy (SET)$20
Emergency Services$115
Urgently Needed Services$25
Worldwide Emergency & Urgent CoverageSee plan details
Worldwide Emergency Coverage$115
Partial Hospitalization Program$115
Intensive Outpatient Program (IOP)$120
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Chiropractic Services$15
Chiropractic ServicesSee plan details
Occupational Therapy Services$20
Physician Specialist Services$20
Podiatry Services$20
Other Health Care Professional Services$0-$20
Psychiatric ServicesSee plan details
Psychiatric Services — Individual SessionsNo charge
Psychiatric Services — Group SessionsNo charge
Physical Therapy & Speech-Language Pathology$20
Additional Telehealth Services (Part B)$0-$25
Opioid Treatment Program Services$20
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & Tests$0-$85
Laboratory Services$0-$50
Radiological ServicesSee plan details
Diagnostic Radiology$0-$75
Therapeutic Radiology20% coinsurance
X-Ray Services$50
Outpatient Hospital Services$0-$450
Hospital Observation Services$115-$450 per stay
Ambulatory Surgical Center (ASC)$50
Substance Abuse — Individual SessionsNo charge
Substance Abuse — Group SessionsNo charge
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance$250
Air Ambulance$250
Durable Medical Equipment (DME)20% coinsurance
Prosthetics & OrthoticsSee plan details
Prosthetic Devices20% coinsurance
Medical Supplies20% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic SuppliesNo charge
Diabetic Therapeutic Shoes & Inserts20% coinsurance
Diabetic MonitorsNo charge
Dialysis Services20% coinsurance
AcupunctureNo charge
Over-the-Counter (OTC) ItemsNo charge
Meal BenefitNo charge
Medicare-Covered Preventive ServicesSee plan details
Annual Physical ExamNo charge
Fitness BenefitNo charge
Remote Access TechnologiesNo charge
Alternative TherapiesNo charge
Kidney Disease Education Services20% coinsurance
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)$35
Dental — Medicare-Covered Services$20
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — Diagnostic ServicesNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — Fluoride TreatmentNo charge
Dental — Other Preventive ServicesNo charge
Dental — ComprehensiveSee plan details
Dental — Restorative ServicesNo charge
Dental — Endodontics (Root Canal)No charge
Dental — Periodontics (Gum Care)No charge
Dental — Removable Prosthodontics (Dentures)No charge
Dental — Oral & Maxillofacial SurgeryNo charge
Dental — Adjunctive General ServicesNo charge
Vision — Eye Exams$0-$20
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — Other Eye ServicesNo charge
Vision — EyewearNo charge
Vision — Eyeglass LensesNo charge
Vision — Eyeglass FramesNo charge
Vision — Eyewear UpgradesNo charge
Hearing — Exams$20
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)No charge
Outpatient Substance Abuse ServicesSee plan details
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge

Service area

  • NY: 58 counties

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