Wellcare Peach State Health Plan Dual Access Open (PPO D-SNP) H0111-004 • 2027 • Bartow County, GA
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Bartow County, GA
- Local Enrollment
- 0 beneficiaries in Bartow County
Introduction
Wellcare Peach State Health Plan Dual Access Open is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by Wellcare. The plan uses a Preferred Provider Organization (PPO) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $0.00 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. CMS Plan ID H0111-004 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
You must live in Bartow County, Georgia to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Bartow County. For assistance with this plan, new members can call (844)480-0680 (TTY 711).
Eligibility
Wellcare Peach State Health Plan Dual Access Open is a Dual Eligible Special Needs Plan (D-SNP) designed for individuals enrolled in both Medicare and Medicaid.
- Special Needs Plan Type
- Dual-Eligible Special Needs Plan (D-SNP)
- Medicare Requirement
- Medicare Part A and Part B
- Special Needs Requirement
- Must qualify for Medicaid
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Bartow County
Compare this plan with the two most-enrolled PPO D-SNP plans available in Bartow County, Georgia. Enrollment is based on CMS local enrollment data.
| Plan Detail | Wellcare Peach State Health Plan Dual Access Open | UHC Dual Complete GA-Q2 | UHC Dual Advantage GA-V1 |
|---|---|---|---|
| CMS Plan ID | H0111-004-0 |
H3256-005-2 |
H3256-006-2 |
| Local Enrollment | 0 | 234 | 177 |
| Monthly Premium | $0.00 | $0.00 | $6.30 |
| Medical Deductible | $0.00 | $0.00 | $0 |
| Maximum Out-of-Pocket | $9,850.00 | $9,850.00 | $7,900.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | 0% or 0%-20% coinsurance | $0 copay |
| Specialist | $0 copay | 0% or 0%-20% coinsurance | $0 or $0-$30 copay |
| Part D Deductible | $700.00 | $700.00 | $700.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Wellcare Peach State Health Plan Dual Access Open has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H0111-004.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H0111-004-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $0 copay - Specialist
- In-network: $0 copay
Out-of-network: $0 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $0 copay - Telehealth benefit
- In-network: $0 copay
- Routine chiropractic
- In-network: $0 copay
Out-of-network: 30% coinsurance - Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
Out-of-network: $0 copay - Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0 copay
Out-of-network: $0 copay - Lab services
- In-network: $0 copay
Out-of-network: $0 copay - Outpatient x-rays
- In-network: $0 copay
Out-of-network: $0 copay - Diagnostic tests and procedures
- In-network: $0 copay
Out-of-network: $0 copay
Emergency and Urgent Care Services
- Emergency room care
- $0 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0 copay
- Inpatient hospital care
- In-network:
Tier 1
$0 per stay
Out-of-network:
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$0 per day for days 21-70
$0 per day for days 71-100
Out-of-network:
$0 per day for days 1-20
$0 per day for days 21-70
$0 per day for days 71-100
$0 per stay - Ground ambulance
- In-network: $0 copay
Out-of-network: $0 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $0 copay
Out-of-network: $0 copay - Outpatient group therapy
- In-network: $0 copay
Out-of-network: $0 copay - Inpatient psychiatric hospital care
- In-network:
Tier 1
$0 per stay
Out-of-network:
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $0 copay
Out-of-network: $0 copay - Occupational therapy
- In-network: $0 copay
Out-of-network: $0 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: $0 copay - Durable medical equipment
- In-network: $0 copay
Out-of-network: $0 copay - Prosthetics
- In-network: $0 copay
Out-of-network: $0 copay
Medicare Part B Drugs
- Chemotherapy
- In-network: $0 copay
Out-of-network: $0 copay - Other Part B drugs (Medicare-covered)
- In-network: $0 copay
Out-of-network: $0 copay
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: 50% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: 50% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: 50% coinsurance - Periodontics
- In-network: $0 copay
Out-of-network: 50% coinsurance - Endodontics
- In-network: $0 copay
Out-of-network: 50% coinsurance - Restorative services
- In-network: $0 copay
Out-of-network: 50% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Out-of-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: 40% coinsurance - Contact lenses
- In-network: $0 copay
Out-of-network: 40% coinsurance - Eyeglass frames only
- In-network: $0 copay
Out-of-network: 40% coinsurance - Eyeglass lenses only
- In-network: $0 copay
Out-of-network: 40% coinsurance - Eyeglasses (frames & lenses)
- In-network: $0 copay
Out-of-network: 40% coinsurance - Upgrades
- In-network: $0 copay
Out-of-network: 40% coinsurance
Hearing Services
- Hearing exam
- In-network: $0 copay
Out-of-network: 40% coinsurance - Fitting/evaluation
- In-network: $0 copay
Out-of-network: 40% coinsurance - Prescription hearing aids
- In-network: $0 copay
Out-of-network: 40% coinsurance - OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- In-network: $0 copay
Out-of-network: $0 copay - Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Wellcare Peach State Health Plan Dual Access Open as a Part B benefit.
Prescription Drug Coverage
Wellcare Peach State Health Plan Dual Access Open includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($9.20) |
| Supplemental Part D Premium: | $9.20 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $6.29 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Wellcare starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Wellcare Peach State Health Plan Dual Access Open may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Generic | $0.00 copay | $19.00 copay |
| Preferred Brand | 25% coinsurance | 20% coinsurance |
| Non-Preferred Drug | 31% coinsurance | $100.00 copay |
| Injectable Drugs | 25% coinsurance | Not available |
| Specialty Tier | 25% coinsurance | 25% coinsurance |
| Select Care Drugs | $0.00 copay | $0.00 copay |
| Preferred Generic | Not available | $5.00 copay |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H0111)
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Wellcare
- Website
- Wellcare Plan Page
- Providers
- Wellcare Providers Page
- Formulary
- Wellcare Formulary Page
- Pharmacy
- Wellcare Pharmacy Page
- New Member Health Plan Help
- (844)480-0680
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)480-0680
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Wellcare (official source) | http://go.wellcare.com/Medicare | October 4, 2026 |
| CMS.gov | Dual Eligible Special Needs Plans (D-SNPs) | April 28, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | April 28, 2026 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | April 28, 2026 |
MedicarePlans.com operates as an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.