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Wellcare Dual Access Open (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access Open (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Dual Access Open (PPO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access Open (PPO D-SNP) is a PPO D-SNP 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 Dual Access Open (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Dual Access Open (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Dual Access Open (PPO D-SNP).
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 Dual Access Open (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.60. 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 $13900.00 (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 $13900.00 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 Dual Access Open (PPO D-SNP) plan features an annual drug deductible of $615. For prescription drugs, Tier 6 Select Care drugs have no copay across all pharmacies and mail-order options. Additionally, Tier 1 Preferred Generic and Tier 2 Generic drugs offer no copay when filled through a three-month preferred mail-order prescription, while retail pharmacy copays start as low as $18 and $19 respectively. For higher-tier medications, Tier 3 Preferred Brand drugs require a 22% coinsurance, and Tier 5 Specialty Tier drugs require a 25% coinsurance for a one-month supply. Tier 4 Non-Preferred Drugs have a set copay starting at $100 for a one-month supply at both preferred and standard pharmacies. This structured tier system helps members understand their out-of-pocket costs when choosing between preferred pharmacies, standard pharmacies, and mail-order services.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers comprehensive coverage for core medical needs, generally featuring no copays alongside a 20% coinsurance for outpatient care, primary care visits, specialist consultations, and diagnostic services. Inpatient hospital stays require a $1,900 copayment per admission with no coinsurance, while emergency room visits carry a $115 copay which is waived if you are admitted. Skilled nursing facility stays are also covered, featuring no copay for days 1 to 20 and days 71 to 100. This plan also includes valuable supplemental benefits to help manage your everyday health costs, including dental, vision, and hearing services with no copays. Preventive and comprehensive dental care, routine hearing evaluations, and up to 12 one-way transportation trips per year are available with no copay or coinsurance. Additionally, members benefit from a $400 annual eyewear allowance and access to over-the-counter items with no copay.
Inpatient Hospital See details
Wellcare Dual Access Open (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,900 copayment per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access Open (PPO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, substance abuse, and blood services—with no copays and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Dual Access Open (PPO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Dual Access Open (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Access Open (PPO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access Open (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, while telehealth has a $0 to $40 copay and 20% coinsurance. Routine podiatry is covered with no copay and no coinsurance, whereas chiropractic benefits are partially covered, offering routine care with no copay and no coinsurance but excluding other chiropractic services.
Preventive Services See details
Preventive services are partially covered under the Wellcare Dual Access Open (PPO D-SNP) plan, offering annual physical exams, fitness benefits, personal emergency response systems, remote access technologies, and alternative therapies with no copay and no coinsurance. Kidney disease education and other diagnostic screenings are covered with no copay and a 20% coinsurance. Sub-services that are not covered include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Wellcare Dual Access Open (PPO D-SNP) covers annual routine hearing exams with no copay and 20% coinsurance, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Wellcare Dual Access Open (PPO D-SNP) covers routine eye exams (one per year) and eyewear—including eyeglasses, frames, and upgrades—with no deductibles, no copays, and a 20% coinsurance on exams and contact lenses. Other eye exam services are not covered, there is a combined $400 annual limit for eyewear, and prior authorization is required.
Dental Services See details
Wellcare Dual Access Open (PPO D-SNP) offers partially covered dental services, with Medicare-covered dental requiring no copay and a 20% coinsurance. Preventive and comprehensive services like cleanings, exams, and implants are covered with no copay and no coinsurance, though prior authorization is required, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access Open (PPO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access Open (PPO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access Open (PPO D-SNP) covers durable medical equipment, prosthetics, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access Open (PPO D-SNP) covers diagnostic and radiological services with no copayment and a 20% coinsurance. These covered services include diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays, all of which require prior authorization.
Home Health Services See details
Home Health Services are covered by Wellcare Dual Access Open (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Dual Access Open (PPO D-SNP) with no copay, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access Open (PPO D-SNP) covers skilled nursing facility (SNF) care with no coinsurance, featuring no copay for days 1 to 20 and 71 to 100, and a $218 daily copay for days 21 to 70. Prior authorization is required, and while a prior three-day hospital stay is not necessary, additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Wellcare Dual Access Open (PPO D-SNP) partially covers other services, providing over-the-counter (OTC) items and a referral-required meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan's additional benefits.
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