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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 2025, 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 GA. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $40.00. 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 $545.00 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 $13300.00 (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 $13300.00 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 has a $545.00 deductible. 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 preferred generic drugs, you will pay a $19.00 copay at preferred pharmacies and a $20.00 copay at standard pharmacies. For specialty tier drugs, there is no copay.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay per admission, while outpatient services often involve a 20% coinsurance. Emergency and urgently needed services have copays, while primary care and many therapies have a 20% coinsurance. Preventive services, including an annual physical, have no copay. Vision services, including eye exams and eyewear, have no copay. Dental services, including exams and cleanings, have no copay. Home health services and skilled nursing facilities also have no copay, but the latter has copays after a period of time.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $2,185 per admission or stay for Inpatient Hospital-Acute and a copay of $2,036 per admission or stay for Inpatient Hospital Psychiatric. 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, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a 20% coinsurance and no copay, while Observation Services have a 20% coinsurance. Outpatient Blood Services have a 20% coinsurance, and the plan waives the deductible for the first three pints of blood. Outpatient Substance Abuse Services including both Individual and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Dual Access Open (PPO D-SNP) plan. This plan has a 20% coinsurance for partial hospitalization services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellcare Dual Access Open (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay and are limited to 12 one-way trips per year. 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 Dual Access Open (PPO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all three have no coinsurance.
Primary Care See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers primary care physician services with a 20% coinsurance and chiropractic services with no copay. Occupational therapy, specialist, mental health, other health, psychiatric, and physical therapy services are covered with a 20% coinsurance. Additional telehealth services are covered with a $0-$45 copay and a 20% coinsurance.
Preventive Services See details
Preventive services, including an annual physical exam, are covered. An annual physical exam has no copay. Kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with 20% coinsurance.
Hearing Services See details
Hearing Services are partially covered by the Wellcare Dual Access Open (PPO D-SNP) plan, but Routine Hearing Exams, Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids (all types), Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. Hearing Exams have a coinsurance of at most 20% and no deductible.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, as well as eyewear with a 20% coinsurance and no copay. Routine eye exams have no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all have no copay.
Dental Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers Medicare Dental Services with a 20% coinsurance. Other Dental Services include oral exams, dental x-rays, and other diagnostic dental services, all with no copay. Additionally, the plan covers prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, but with visit limits and other restrictions; however, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services are covered up to a maximum of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access Open (PPO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Wellcare Dual Access Open (PPO D-SNP) plan. Durable Medical Equipment (DME) is covered with a 20% coinsurance. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests and Radiological Services have a coinsurance of at most 20%, while Lab Services have a coinsurance of at most 20% and no copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access Open (PPO D-SNP) 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 not covered by the Wellcare Dual Access Open (PPO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services offered by the Wellcare Dual Access Open (PPO D-SNP) plan include Over-the-Counter (OTC) Items and Meal Benefit, with no copay for either. 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.
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