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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 2025, 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 2025.
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 $26.20. 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 $590.00 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 $6350.00 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) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs based on the tier and pharmacy you use, until your total drug costs reach $2000. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $26.20.
Additional Benefits
The Wellcare Dual Reserve (HMO-POS D-SNP) plan provides comprehensive coverage with a variety of benefits. This plan features no copays for primary care visits, routine eye exams, and many dental services, as well as a $0 copay for home health services. Additionally, the plan covers hearing exams, hearing aids, vision services, and offers coverage for emergency services, outpatient services, and inpatient hospital stays with varying copays. This plan also offers a range of other services, including coverage for ambulance and transportation, partial hospitalization, and skilled nursing facilities, with specific copays and coverage limits. Other notable benefits include coverage for acupuncture, over-the-counter items, and a meal benefit for chronic illnesses. However, some services such as cardiac rehabilitation, additional hours of care, and specific types of hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For the first 4 days of an inpatient stay, there is a $375 copay, and days 5-90 have no copay; additional days and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $375, observation services with a copay between $125 and $375, ambulatory surgical center services with a $200 copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay. These services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. Ground and air ambulance services have a $300 copay, while transportation services to a plan-approved health-related location have no copay and cover up to 12 one-way trips per year using rideshare services, bus/subway, and medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $35 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered, and Worldwide Emergency Services has a maximum benefit coverage of $50,000.
Primary Care See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services with a $25 copay, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay ranging from $0 to $35, and opioid treatment program services with a $25 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services that may have a copay. Kidney disease education services have a 20% coinsurance. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $25 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a maximum benefit of $750 per year, and prescription hearing aids (all types) have no copay for 2 visits per year; however, prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Wellcare Dual Reserve (HMO-POS D-SNP) covers vision services, including eye exams and eyewear. Routine eye exams have no copay, and other eye exams have a copay between $0 and $25; eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, and a combined maximum benefit of $200 per year.
Dental Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery, all with no copay. Medicare dental services have a $25 copay. Orthodontic services are covered up to a maximum of $1500 per year. Prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Reserve (HMO-POS D-SNP) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $30, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $300, Therapeutic Radiological Services with at least 20% coinsurance, and Outpatient X-Ray Services with a $25 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Reserve (HMO-POS D-SNP) plan, but require prior authorization. For days 1-20, there is no copay; for days 21-40, the copay is $214; and for days 41-100, there is no copay.
Other Services See details
The Wellcare Dual Reserve (HMO-POS D-SNP) plan covers acupuncture with no copay, but requires prior authorization and is limited to 24 treatments per year. Over-the-counter (OTC) items are covered with no copay, including nicotine replacement therapy and Naloxone. The plan also provides a meal benefit for chronic illnesses with no copay and requires a doctor's referral. However, several other "Other Services" are not covered.
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