Wellcare Simple Value (HMO-POS)

Oregon Medicare Advantage Plan (2025 Plan)


Monthly Premium

Your Cost
$0
by Wellcare by Health Net

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 3.0
out of 5 stars

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Plan Name
Wellcare Simple Value (HMO-POS)
Insurance Carrier
Wellcare by Health Net
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Wellcare Simple Value (HMO-POS) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Oregon and offered by the health insurance company Wellcare by Health Net. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$150 In-network
Max Out-of-Pocket
$6,600
Primary doctor visit
$0 copay
Specialist visit
$25 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$310 copay

Wellcare Simple Value (HMO-POS) has a monthly premium cost of $0 per month, with an annual deductible of $150 In-network and a maximum out of pocket cost sharing of $6,600 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Wellcare Simple Value (HMO-POS) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Wellcare Simple Value (HMO-POS) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Wellcare Simple Value (HMO-POS) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Wellcare Simple Value (HMO-POS) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Wellcare Simple Value (HMO-POS) received an overall government quality rating of 3.0 stars out of 5 stars.

Wellcare Simple Value (HMO-POS) performed worse than Oregon’s State average overall quality score of 3.5 stars.

This Plan’s 5-star Gov’t Quality Score
Oregon State Average Score
Overall Government 5 Star Quality Rating
 3.0
 3.5
Summary rating of health plan quality
 3
 3.4
Staying healthy: screenings, tests, & vaccines
 3
 3.7
Managing chronic (long term) conditions
 3
 3.2
Member experience with health plan
 2
 2.8
Member complaints & changes in the health plan's performance
 3
 4.0
Health plan customer service
 4
 3.8
Summary rating of drug plan quality
 3
 3.5
Drug plan customer service
 4
 3.8
Member complaints & changes in the drug plan's performance
 3
 4.0
Member experience with the drug plan
 1
 3.0
Drug safety & accuracy of drug pricing
 3
 3.1

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Wellcare Simple Value (HMO-POS) received 3 stars for its health plan quality score which is worse than the Oregon State average health plan quality score of 3.4 stars.

Wellcare Simple Value (HMO-POS) received 3 stars for its drug plan quality score which is worse than the Oregon State average drug plan quality score of 3.5 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$150 In-network
Health Plan Max Out-of-Pocket
$6,600 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
In-network: $0 copay
Specialist visit
In-network: $25 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay or 20% coinsurance
Lab services
In-network: $0-50 copay
Diagnostic radiology services (like MRI)
In-network: $0-500 copay
Outpatient x-rays
In-network: $75 copay
Emergency care
$125 copay per visit (always covered)
Urgent care
$55 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $673 per day for days 1 through 4
$0 per day for days 5 through 90
Out-of-network: Not Applicable
Outpatient hospital coverage
In-network: $0-500 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$214 per day for days 21 through 50
$0 per day for days 51 through 100
Out-of-network: Not Applicable

Preventive services

Preventive services
In-network: $0 copay

Ambulance

Ground ambulance
In-network: $310 copay

Therapy services

Occupational therapy visit
In-network: $45 copay
Physical therapy & speech & language therapy visit
In-network: $45 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $25 copay
Outpatient individual therapy with a psychiatrist
In-network: $25 copay
Outpatient group therapy visit
In-network: $25 copay
Outpatient individual therapy visit
In-network: $25 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Diabetes supplies
In-network: $0 copay per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$5.00 copay$0 copay
Generic$10.00 copay$0 copay
Preferred Brand25% coinsurance$0 copay
Non-Preferred Drug43% coinsurance$0 copay
Specialty Tier28% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance

Hearing

Hearing exam
In-network: $25 copay
Fitting/evaluation
In-network: $0 copay
Hearing aids - All types
In-network: $0 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: 25% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 25% coinsurance
Fluoride treatment
In-network: $0 copay
Out-of-network: 25% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: 25% coinsurance

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
In-network: $0 copay
Out-of-network: 25% coinsurance

Vision

Routine eye exam
In-network: $0 copay
Contact lenses
In-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Eyeglass frames (only)
In-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Upgrades
In-network: $0 copay

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