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Wellcare Low Premium (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Low Premium (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Low Premium (HMO-POS) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Low Premium (HMO-POS) is a HMO-POS plan offered by Health Net Health Plan of Oregon, Inc. available for the 2026 plan year to people living in Select counties in OR. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Low Premium (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Low Premium (HMO-POS).
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 Low Premium (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7900.00 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:
Sign up for Wellcare Low Premium (HMO-POS)
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Drug Coverage
The Wellcare Low Premium (HMO-POS) Medicare plan has an annual prescription drug deductible of $615. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled through a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options are also available, with generic copays ranging from $5 to $30 depending on the tier and supply. For brand-name and specialty medications, Tier 3 preferred brand and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs have a 35% to 36% coinsurance. Additionally, Tier 6 select care drugs are covered with no copay at all standard and preferred pharmacies and mail-order services. This plan offers a balanced cost structure for beneficiaries seeking affordable coverage for generic and select care prescriptions.
Additional Benefits
The Wellcare Low Premium (HMO-POS) plan offers comprehensive coverage for essential medical services, often featuring no copayments or low fixed costs. Beneficiaries enjoy no copay for primary care visits and a low $25 copay for specialist visits, both with no coinsurance. For emergency situations, emergency room visits require a $115 copay, while acute inpatient hospital stays feature a $600 copay for days one through four and no copay for days five through ninety. Routine vision exams and preventive dental care are covered with no copay, while Medicare-covered dental and hearing exams require a $25 copay. The plan also covers routine eyewear up to $100 annually and prescription hearing aids up to $500 per ear with no copay. Additionally, home health services and diagnostic lab tests are provided with no copay, while durable medical equipment requires a 20% coinsurance.
Inpatient Hospital See details
Wellcare Low Premium (HMO-POS) partially covers inpatient hospital services with no coinsurance, though upgrades, additional days, and non-Medicare-covered stays are not covered. For acute inpatient stays, there is a $600 copay for days 1 to 4 and no copay for days 5 to 90, while psychiatric stays require a $400 copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
Wellcare Low Premium (HMO-POS) covers outpatient hospital services with a copay ranging from no copay to $500 and 20% coinsurance, and observation services with a $115 copay per stay and 20% coinsurance. Ambulatory surgical center services require a $300 copay and no coinsurance, outpatient substance abuse sessions carry a $25 copay and no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Low Premium (HMO-POS) with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellcare Low Premium (HMO-POS) covers Medicare-approved ground and air ambulance services with a $310.00 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Low Premium (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance, and these costs count toward the plan deductible. Worldwide emergency and urgent care are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Low Premium (HMO-POS) covers primary care provider visits with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Physical, occupational, and speech therapy require copays ranging from $35 to $45 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Low Premium (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for annual physicals, alternative therapies, fitness benefits, remote access, and other screenings, while kidney disease education is covered with no copay and 20% coinsurance. Non-covered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Wellcare Low Premium (HMO-POS) hearing services feature a $25 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams and fittings with no copay or coinsurance. Prescription hearing aids are partially covered up to $500 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Wellcare Low Premium (HMO-POS) provides partially covered vision services, offering one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear, including contact lenses and eyeglasses, is covered with no copay and no coinsurance up to a combined maximum benefit of $100 per year.
Dental Services See details
Wellcare Low Premium (HMO-POS) dental benefits are partially covered, offering Medicare-covered dental services for a $25 copay and no coinsurance, plus preventive care and adjunctive general services with no copay and no coinsurance. However, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Wellcare Low Premium (HMO-POS) covers home infusion bundled services with no copay, although prior authorization and step therapy may be required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Low Premium (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Low Premium (HMO-POS), with durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts requiring a 20% coinsurance and no copay. Diabetic supplies are covered with no copay, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Wellcare Low Premium (HMO-POS) diagnostic and radiological services are covered with prior authorization, featuring no copays for lab services, diagnostic procedures, and diagnostic radiology. Diagnostic procedures and therapeutic radiology carry a 20% coinsurance, while outpatient X-rays require a $50 copay, with coinsurance also applying to lab and X-ray services.
Home Health Services See details
Home Health Services are covered under the Wellcare Low Premium (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Wellcare Low Premium (HMO-POS) plan. Although there is no coinsurance, all specific sub-services—including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET)—are not covered and carry copays between $20 and $40.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Wellcare Low Premium (HMO-POS) with no coinsurance and requires prior authorization, though a prior three-day hospital stay is not required. There is no copay for days 1 through 20 and days 61 through 100, but a $218 daily copay applies for days 21 through 60, and additional days beyond standard Medicare-covered limits are not covered.
Other Services See details
Other Services are not covered under the Wellcare Low Premium (HMO-POS) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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