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Wellcare Simple Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple Open (PPO) in 2026, please refer to our full plan details page.
Wellcare Simple Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in MS. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Simple Open (PPO) 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 Simple Open (PPO).
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 Simple Open (PPO), 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 combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Simple Open (PPO) Medicare prescription drug plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when using preferred pharmacies or preferred mail order. Standard pharmacies are also highly affordable, with copays starting at just $5 for Tier 1 and $10 for Tier 2 medications. For brand-name and specialty medications, costs are covered via coinsurance, with Tier 3 preferred brands and Tier 5 specialty drugs requiring 25% coinsurance. Tier 4 non-preferred drugs carry a 36% coinsurance at preferred pharmacies and mail order, which increases slightly to 37% at standard pharmacies. This structured coverage ensures predictable out-of-pocket costs for a wide range of prescription needs.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers comprehensive coverage with many essential services featuring no copay and no coinsurance, including primary care, telehealth, and home health services. For specialist visits, urgent care, and emergency services, members pay predictable flat copays ranging from $20 to $130 with no coinsurance. Inpatient hospital stays require a $375 daily copay for the first eight days followed by no copay, while skilled nursing facility stays are covered with no copay for the first 20 days. In addition, the plan provides routine dental, vision, and hearing benefits with no copay and no coinsurance up to specified annual limits. Prescription hearing aids, eyewear, and preventive dental care are covered with no copay up to their respective maximum allowances. Other key services, such as diagnostic lab tests and diabetic supplies, require no copay, while durable medical equipment and dialysis services are covered with a 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple Open (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $375 daily copay for days 1 through 8 and no copay for days 9 through 90, while psychiatric stays require a $2,175 copay per stay; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple Open (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with copays ranging from $0 to $500 and observation services with a $130 to $500 copay per stay. Ambulatory surgical center services require a $300 copay with no coinsurance, outpatient substance abuse sessions have a $25 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Simple Open (PPO) 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 Simple Open (PPO) covers ground and air ambulance services with a $325 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Wellcare Simple Open (PPO) covers emergency services with a $130 copay and urgent care with a $40 copay, both featuring no coinsurance and waived fees if admitted within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple Open (PPO) covers primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist, mental health, and physical therapy services require copays ranging from $20 to $25 and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Wellcare Simple Open (PPO) partially covers preventive services, offering annual physical exams, fitness benefits, alternative therapies, and remote access technologies with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, though several supplemental benefits like health education, nutritional services, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Simple Open (PPO), featuring a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Up to two prescription hearing aids are covered per year with no copay or coinsurance up to a $500 maximum per ear, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Simple Open (PPO) vision services are partially covered, as other eye exam services are not covered under the plan. Covered routine eye exams and eyewear—including contacts and eyeglasses—feature no copay and no coinsurance, with eyewear limited to a combined maximum of $200 per year.
Dental Services See details
Wellcare Simple Open (PPO) offers partially covered dental services, with Medicare-covered dental requiring a $25 copay and no coinsurance, and preventive and covered comprehensive services having no copay and no coinsurance up to a $2,000 annual limit. Prosthodontics (fixed and removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple Open (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple Open (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple Open (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts have no copay and a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Simple Open (PPO) diagnostic and radiological services are covered with prior authorization, featuring no coinsurance and no copay for lab services, and a $0 to $40 copay for diagnostic tests. Diagnostic radiological services have no copay, outpatient X-rays require a $50 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple Open (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Simple Open (PPO) with no copay and no coinsurance. Although some services are covered, standard cardiac, intensive cardiac, pulmonary, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Simple Open (PPO) with no coinsurance, though prior authorization is required. There is no copay for days 1 through 20 and days 61 through 100, while days 21 through 60 require a $218 daily copay, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple Open (PPO) provides partial coverage for Other Services, which includes a meal benefit for chronic illnesses with no copay and no coinsurance, though a referral is required. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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