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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 2025, 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 2025.
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 $420.00 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 $4150.00 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 has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, there is no copay when using preferred or mail-order pharmacies, and a $10 copay at standard pharmacies. For specialty tier drugs, there is no copay at any pharmacy.
Additional Benefits
The Wellcare PeaceHealth Simple (HMO-POS) plan offers comprehensive coverage, including inpatient hospital stays with a copay, and outpatient services with varying copays. This plan also includes benefits for primary care, hearing, vision, and dental services, often with no copay or a low copay. The plan covers ambulance services, emergency services, and a variety of services like home health and skilled nursing facility with different cost sharing.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $150 copay for days 1-4, and no copay for days 5-90, for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days and non-Medicare covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $500, Observation Services with a copay between $140 and $200, Ambulatory Surgical Center (ASC) Services with a $100 copay, Outpatient Substance Abuse Services with a $25 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare PeaceHealth Simple (HMO-POS) plan, with a $130 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare PeaceHealth Simple (HMO-POS) plan. Ground and air ambulance services each have a $305 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered with a $140 copay and no coinsurance, while urgently needed services have a $55 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $140 copay and no coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare PeaceHealth Simple (HMO-POS) plan covers primary care physician services with a copay between $0 and $60, chiropractic services with no copay, occupational therapy services with a $10 copay, and physician specialist services with a copay between $10 and $60. The plan also covers mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits with a copay between $0 and $60, and opioid treatment program services.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional services that may require a copay. Kidney disease education services have a 20% coinsurance. Other preventive services include no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per ear, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams, with a copay of $0-$60, and eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, with no copay and a combined maximum benefit of $200 per year. Routine eye exams have no copay and are limited to one per year.
Dental Services See details
The Wellcare PeaceHealth Simple (HMO-POS) plan covers Medicare Dental Services with a copay of $10-$60, and other 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, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Orthodontic Services are covered up to a maximum of $1500 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis services are covered by the Wellcare PeaceHealth Simple (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment which includes Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $40, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $500, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare PeaceHealth Simple (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare PeaceHealth Simple (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. There is no copay for days 1-20 and days 71-100, but there is a $214 copay for days 21-70.
Other Services See details
The Wellcare PeaceHealth Simple (HMO-POS) 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, with a maximum benefit of $122 every three months. The plan also covers a meal benefit with no copay and a doctor referral. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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