Wellcare Peach State Health Plan Dual Reserve (HMO-POS D-SNP) Medicare Special Need Plan H1112-046 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7500.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 1,632 beneficiaries
Introduction
Wellcare Peach State Health Plan Dual Reserve, offered by Wellcare, is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) identified by CMS Plan ID H1112-046. The plan's Health Maintenance Organization with a Point of Service (HMO-POS) provider network serves its covered medical benefits, and the plan includes Medicare Part D prescription drug coverage. Its 2027 costs include a $0.00 monthly premium, $0.00 medical deductible, and $7500.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
This plan has 1,632 beneficiaries enrolled across its service areas based on CMS enrollment data. To enroll, you must live within the plan's service area: See List.
Eligibility
Wellcare Peach State Health Plan Dual Reserve 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.
Plan Benefits
Wellcare Peach State Health Plan Dual Reserve 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 H1112-046.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay |
| Specialist | In-network: $0 or $15 copay | In-network: $0 or $15 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0 or $0-$40 copay | In-network: $0 or $0-$40 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0 or $0-$350 copay | In-network: $0 or $0-$300 copay |
| Lab services | In-network: $0 or $0-$50 copay | In-network: $0 or $0-$50 copay |
| Outpatient x-rays | In-network: $0 or $50 copay | In-network: $0 or $50 copay |
| Diagnostic tests and procedures | In-network: $0 or $0-$20 copay | In-network: $0 or $0-$20 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $0 or $115 copay | $0 or $115 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | $0 or $40 copay | $0 or $40 copay |
| Inpatient hospital care | In-network: Tier 1 $0 or $400 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
In-network: Tier 1 $0 or $400 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $0 or $221 per day for days 21-60 $0 per day for days 61-100 |
In-network: Tier 1 $0 per day for days 1-20 $0 or $218 per day for days 21-60 $0 per day for days 61-100 |
| Ground ambulance | In-network: $0 or $285 copay | In-network: $0 or $285 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0 or $25 copay | In-network: $0 or $25 copay |
| Outpatient group therapy | In-network: $0 or $25 copay | In-network: $0 or $25 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $0 or $400 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
In-network: Tier 1 $0 or $400 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $0 or $10 copay | In-network: $0 or $10 copay |
| Occupational therapy | In-network: $0 or $10 copay | In-network: $0 or $10 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: $0 copay |
| Durable medical equipment | In-network: 0% or 20% coinsurance | In-network: 0% or 20% coinsurance |
| Prosthetics | In-network: 0% or 20% coinsurance | In-network: 0% or 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0% or 0%-20% coinsurance | In-network: 0% or 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0% or 0%-20% coinsurance | In-network: 0% or 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Restorative services | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: 25% coinsurance |
In-network: $0 copay Out-of-network: 25% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | In-network: $0 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay | In-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay | In-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | In-network: $0 copay | In-network: $0 copay |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | In-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay | In-network: $0 copay |
| Prescription hearing aids | In-network: $0 copay | In-network: $0 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | In-network: $0 copay |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | In-network: $0 copay | In-network: $0 copay |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by Wellcare Peach State Health Plan Dual Reserve as a Part B benefit.
Prescription Drug Coverage
Wellcare Peach State Health Plan Dual Reserve 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: | ($8.50) |
| Supplemental Part D Premium: | $8.50 |
| 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 Reserve 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 | 21% coinsurance |
| Non-Preferred Drug | 30% 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 | $18.00 copay |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H1112)
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.
Plan Availability
Wellcare Peach State Health Plan Dual Reserve (H1112-046-0) is available in the following locations (click to open):
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | November 10, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Wellcare (official source) | http://www.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 |
| Medicare.gov | Joining a plan | April 28, 2026 |
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