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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 2025, 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 out of 5 stars in 2025.
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 $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 combined Maximum Out-Of-Pocket cost of $8950.00 (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 $8950.00 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) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and mail order, but have a $10 copay at standard pharmacies. Specialty tier drugs have no copay at any pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $500. Emergency services, primary care, and preventive services often have no copay, while hearing, vision, and dental services are covered with set copays or maximum benefits. This plan provides coverage for ambulance, home health, and skilled nursing facility services. The plan also covers home infusion and dialysis services. Additionally, the plan includes coverage for durable medical equipment, diagnostic and radiological services, and cardiac rehabilitation services, with some services having copays, coinsurance, or maximum benefit limits.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $299 for days 1-10 and no copay for days 11-90 for Inpatient Hospital-Acute services, and a copay of $2,175 for Inpatient Hospital Psychiatric services. Additional Days, Non-Medicare-covered Stays, and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Wellcare Simple Open (PPO) plan covers outpatient services including outpatient hospital services with a copay of $0 - $500, observation services with a copay of $125 - $500, ambulatory surgical center services with a $300 copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay. Outpatient blood services also have a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple Open (PPO) plan with a $105 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple Open (PPO) plan. Ground and air ambulance services have a $250 copay, but there is no coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage each have a copay of $125.00, $40.00, and $125.00, respectively, with no coinsurance; Worldwide Urgent Coverage has a $125.00 copay and no coinsurance; Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Open (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $20 copay, Physician Specialist Services with a $20 copay, Mental Health Specialty Services with a $25 copay for individual and group sessions, Other Health Care Professional services with a copay between $0 and $20, Psychiatric Services with a $25 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $20 copay, Additional Telehealth Benefits with a copay between $0 and $40, and Opioid Treatment Program Services with a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered under the Wellcare Simple Open (PPO) plan. The plan covers an annual physical exam with no copay, and also covers additional preventive services, including Medicare-covered zero-dollar preventive services, with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
Hearing exams are covered with a $20 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered with a $500 maximum plan benefit per ear per year, and are limited to 2 visits per year with no copay, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and over-the-counter hearing aids are not covered.
Vision Services See details
The Wellcare Simple Open (PPO) plan covers vision services, including eye exams with a copay between $0 and $20, and eyewear with no copay. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The Wellcare Simple Open (PPO) plan covers Medicare Dental Services with a $20 copay. Other Dental Services include oral exams, dental x-rays, and other diagnostic, preventive, restorative, and adjunctive services with no copay, but coverage limits apply. Orthodontic services are covered up to a $3000 maximum benefit per year, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare Simple Open (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple Open (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The Wellcare Simple Open (PPO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services, are covered. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $40, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a copay of $75.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple Open (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Simple Open (PPO) plan, but none of the sub-services are covered. There is a copay for this service, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Open (PPO) plan, with prior authorization required. For days 1-20 and 51-100, there is no copay, but for days 21-50, there is a $214 copay.
Other Services See details
The Wellcare Simple Open (PPO) plan's Other Services benefit covers over-the-counter items with no copay, and a meal benefit with no copay, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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. The plan provides up to $62 every three months for over-the-counter items.
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