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Wellcare PeaceHealth Simple (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare PeaceHealth Simple (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare PeaceHealth Simple (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare PeaceHealth Simple (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in Oregon. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare PeaceHealth Simple (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 PeaceHealth Simple (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 PeaceHealth Simple (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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
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 $5900.00 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 PeaceHealth Simple (HMO-POS) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using preferred pharmacies or preferred mail order services, while standard pharmacies require copays starting at $5. Additionally, Tier 6 select care drugs are highly affordable with no copay across all standard and preferred pharmacy and mail order options. For higher-tier prescriptions, costs transition to coinsurance percentages rather than flat copays. Members pay a 25% coinsurance for Tier 3 preferred brand and Tier 5 specialty drugs, while Tier 4 non-preferred drugs require a 50% coinsurance across all pharmacy and mail order options.
Additional Benefits
The Wellcare PeaceHealth Simple (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no coinsurance for inpatient hospital stays, outpatient services, and primary care visits. Inpatient hospital stays require a $150 daily copay for the first four days and no copay for days five through 90, while emergency room visits carry a $130 copay that is waived if you are admitted. Primary care visits range from no copay up to $55, and most preventive services, home health visits, and laboratory tests are available with no copay or coinsurance. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing services with no copay and no coinsurance, including up to $500 per ear annually for hearing aids and a $200 annual maximum for eyewear. Skilled nursing facility care features no copay for days 1 through 20 and 51 through 100, while days 21 through 50 require a $218 daily copay. Additionally, durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare PeaceHealth Simple (HMO-POS) covers inpatient acute and psychiatric hospital care with no coinsurance, requiring a $150 daily copay for days 1 to 4 and no copay for days 5 to 90 per stay. This benefit is partially covered, as prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare PeaceHealth Simple (HMO-POS) with no coinsurance, featuring outpatient hospital copays ranging from no copay to $500 and ambulatory surgical center services for a $100 copay. Additionally, outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare PeaceHealth Simple (HMO-POS) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Wellcare PeaceHealth Simple (HMO-POS) covers ground and air ambulance services with a $305 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the Wellcare PeaceHealth Simple (HMO-POS) plan are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, and worldwide emergency services are partially covered up to a $50,000 limit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care services under the Wellcare PeaceHealth Simple (HMO-POS) plan are covered with no coinsurance and copays ranging from no copay up to $55.00. While most services like specialist visits, mental health, and physical therapy are covered, chiropractic benefits are only partially covered since other non-routine chiropractic services are not covered.
Preventive Services See details
Wellcare PeaceHealth Simple (HMO-POS) partially covers preventive services, offering annual physicals, alternative therapies, memory fitness, and select screenings with no copay and no coinsurance, alongside kidney disease education for no copay and a 20% coinsurance. Excluded services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare PeaceHealth Simple (HMO-POS) covers Medicare-covered hearing exams with a $10 copay and no coinsurance, while routine exams and fitting evaluations are covered with no copay or coinsurance. Prescription hearing aids are partially covered up to $500 per ear annually with no copay or coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Wellcare PeaceHealth Simple (HMO-POS) covers vision services with no deductible and no coinsurance, offering routine eye exams and eyewear with no copay. Eyewear has a combined annual maximum benefit of $200, though other eye exam services are not covered and prior authorization is required.
Dental Services See details
Wellcare PeaceHealth Simple (HMO-POS) partially covers dental services, offering covered preventive and select comprehensive services with no copay and no coinsurance, while Medicare-covered dental services require a $10.00 to $40.00 copay and no coinsurance. Uncovered sub-services include orthodontics, implant services, maxillofacial prosthetics, and both fixed and removable prosthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare PeaceHealth Simple (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from no coinsurance to 20%, while covered Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Wellcare PeaceHealth Simple (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare PeaceHealth Simple (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, and prior authorization is required for most of these covered equipment and supplies.
Diagnostic and Radiological Services See details
Wellcare PeaceHealth Simple (HMO-POS) covers diagnostic and radiological services with prior authorization required. Diagnostic tests have a $0 to $40 copay and no coinsurance, while lab services have no copay and no coinsurance. Radiological services feature a $50 copay plus coinsurance for X-rays, a minimum $0 copay for diagnostic radiology, and a minimum 20% coinsurance plus a copay for therapeutic radiology.
Home Health Services See details
Wellcare PeaceHealth Simple (HMO-POS) 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 by Wellcare PeaceHealth Simple (HMO-POS) with no coinsurance. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare PeaceHealth Simple (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 51 through 100, a $218 daily copay for days 21 through 50, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other services are partially covered by Wellcare PeaceHealth Simple (HMO-POS), which offers acupuncture (up to 24 treatments yearly with prior authorization) and over-the-counter items with no copay and no coinsurance. Meal benefits and other additional services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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