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Wellcare Dual Reserve (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Reserve (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Dual Reserve (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Reserve (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Oregon. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Dual Reserve (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Dual Reserve (HMO-POS D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Dual Reserve (HMO-POS D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellcare Dual Reserve (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.50. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Wellcare Dual Reserve (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $615, with costs varying based on your pharmacy choice and drug tier. For Tier 6 select care drugs, you will pay no copay when using preferred retail pharmacies or preferred mail-order services. Tier 1 preferred generics and Tier 2 generics offer affordable copays starting at $18 and $19 respectively, and you can enjoy no copay on three-month supplies of these drugs when using preferred mail order. Higher-tier medications under this plan transition to coinsurance or set copayments. Tier 3 preferred brands and Tier 5 specialty drugs both carry a 25% coinsurance, while Tier 4 non-preferred drugs require a copay starting at $100 for a one-month supply. Utilizing preferred pharmacies and preferred mail-order options provides the greatest savings on your prescription medication costs.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) offers comprehensive medical coverage featuring no copay for primary care visits, home health services, and routine preventive care. For more intensive services, inpatient hospital stays require a $425 daily copay for the first four days followed by no copay, while emergency room visits carry a $130 copay that is waived upon admission. Outpatient hospital services and specialist visits are also covered, with specialists requiring a $25 copay and no coinsurance. This plan also includes strong supplemental benefits, offering no copay for preventive and comprehensive dental care up to $1,500 annually, alongside no copay for routine eye exams and up to $200 for eyewear. Members also benefit from no copay on acupuncture and over-the-counter items, while durable medical equipment is covered with no copay and a twenty percent coinsurance. Routine hearing exams are available with no copay, plus up to $500 per ear annually for covered prescription hearing aids.
Inpatient Hospital See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers inpatient acute hospital stays with no coinsurance and a $425 daily copay for days 1 through 4, and no copay for days 5 through 90. Inpatient psychiatric care is also covered with no coinsurance and a $375 daily copay for days 1 through 4, and no copay for days 5 through 90, though additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $425 copay, observation services with a $130 to $425 copay per stay, and ambulatory surgical center services with a $200 copay. Outpatient substance abuse sessions require a $25 copay with no coinsurance, and outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers ground and air ambulance services with a $300 copay per service and no coinsurance, with prior authorization required. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services under the Wellcare Dual Reserve (HMO-POS D-SNP) are covered with a $130 copay and no coinsurance, and urgently needed services require a $35 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum benefit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy, and mental health services generally require a $25 copay and no coinsurance. Chiropractic services are partially covered, offering routine care for a $15 copay and no coinsurance, but other chiropractic services are not covered.
Preventive Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) provides partially covered preventive services with no copay and no coinsurance for annual physicals, memory fitness, alternative therapies, remote access, and routine screenings, while kidney disease education is covered with no copay and a 20% coinsurance. Sub-services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, extended tobacco cessation counseling, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers hearing services with a $25 copay and no coinsurance for Medicare-covered exams, plus annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) offers partially covered vision services with no coinsurance, no deductibles, and copays ranging from $0 to $25. There is no copay for one routine eye exam per year and eyewear up to a $200 annual limit, but other eye exam services are not covered.
Dental Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) partially covers dental services, offering Medicare-covered dental care for a $25 copay and no coinsurance, and preventive and comprehensive services with no copay and no coinsurance. While restorative care, endodontics, periodontics, and oral surgery are covered up to a $1,500 yearly limit, prosthodontics, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts require a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers diagnostic and radiological services, requiring prior authorization for all services. Diagnostic tests and lab services feature no coinsurance and copays ranging from no copay up to $30, while radiological services carry a $50 copay for X-rays and a minimum 20% coinsurance for therapeutic treatments.
Home Health Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Wellcare Dual Reserve (HMO-POS D-SNP) with no coinsurance, meaning some services are covered, though cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice. These non-covered services require copayments of $40 for cardiac, $50 for intensive cardiac, $35 for pulmonary, and $25 for SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Dual Reserve (HMO-POS D-SNP) with no coinsurance, requiring no copay for days 1-20 and 61-100, and a $218 daily copay for days 21-60. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) provides partial coverage for other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Acupuncture requires prior authorization and is limited to 24 treatments per year, and OTC items are available via reimbursement.
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