A non-government entity
Wellcare Mutual of Omaha Simple Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Mutual of Omaha 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 Mutual of Omaha Simple Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Mutual of Omaha Simple Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in GA. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Mutual of Omaha 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 Mutual of Omaha 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 Mutual of Omaha 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 $10000.00 (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 $10000.00 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 Mutual of Omaha Simple Open (PPO) plan has a $420.00 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies or mail order, but a $10 copay at standard pharmacies. Specialty tier drugs have no copay at any pharmacy. Other tiers have coinsurance percentages between 25% and 46%.
Additional Benefits
The Wellcare Mutual of Omaha Simple Open (PPO) plan offers comprehensive coverage with varying costs depending on the service. This plan includes no copay for primary care physician services, preventive services, and many dental and vision services. It also offers coverage for inpatient and outpatient services, with copays ranging from $0 to $1590 depending on the specific service. This plan provides coverage for ambulance services, emergency services, and hearing aids, with copays and coinsurance applying in different situations. Additionally, the plan includes benefits for home health, skilled nursing facilities, and other services, such as over-the-counter items, with specific copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $375 per admission for days 1-7, and no copay for days 8-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a copay of $1590 per admission. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $400, observation services with a copay between $125 and $400, and ambulatory surgical center services with a $250 copay. This plan also covers outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan. There is a $105 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan, with a $290 copay for both ground and air ambulance services and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare Mutual of Omaha Simple Open (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services have a $30 copay, all with no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care includes coverage for several services. Primary Care Physician Services have no copay, Chiropractic Services have a $20 copay, Occupational Therapy Services have a $40 copay, and Physician Specialist Services have a $40 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40 copay for both individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Additional Telehealth Benefits have a copay between $0 and $40. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services with a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services are covered 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 $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $500 per ear, per year, with no copay for Prescription Hearing Aids (all types). Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Mutual of Omaha Simple Open (PPO) plan covers vision services including eye exams with a copay of $0-$40, and eyewear with no copay and a combined maximum benefit of $100 per year for both in-network and out-of-network services. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $40 copay. Other Dental Services cover oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, oral and maxillofacial surgery, restorative services, adjunctive general services, endodontics, and periodontics with no copay. Orthodontic Services are covered up to a maximum of $2000 per year. However, prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
The Wellcare Mutual of Omaha Simple Open (PPO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, but does not cover DME for use outside the home. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $75, lab services with no copay, diagnostic radiological services with a copay up to $400, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $75 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan, but the specific services are not covered. There is a copay for some services, but the specific copay information is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan. For days 1-20 and 61-100, there is no copay, while days 21-60 have a $214 copay; this plan does not cover additional days beyond Medicare-covered days or non-Medicare-covered stays.
Other Services See details
The Wellcare Mutual of Omaha Simple Open (PPO) plan covers Over-the-Counter (OTC) Items with no copay, up to $75 every three months. Acupuncture, meal benefits, and several other services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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