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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 GA. 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 $25.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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) prescription drug plan features an annual drug deductible of $615. For Select Care Drugs in Tier 6, members enjoy no copay across all pharmacy types and mail-order options. Tier 1 preferred generic drugs are highly affordable, costing as little as a $5 copay for a 1-month supply at preferred pharmacies, and there is no copay for a 3-month supply filled via preferred mail order. Standard generic drugs in Tier 2 carry a $19 copay for a 1-month supply at preferred pharmacies, but also feature no copay for a 3-month preferred mail-order supply. Higher-tier medications require coinsurance, with Tier 3 preferred brand drugs subject to a 20% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. Tier 4 non-preferred drugs require a $100 copay for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers comprehensive coverage where many routine and outpatient services feature no copay but require a 20% coinsurance. This 20% coinsurance structure applies to primary care, specialist visits, outpatient hospital services, diagnostic tests, and durable medical equipment. For emergency situations, there is a $115 copay for emergency room visits and a $40 copay for urgent care, both with no coinsurance. Inpatient hospital stays require a copayment of $2,215 for acute care and $2,080 for psychiatric care per stay with no coinsurance. Skilled Nursing Facility stays feature no copay for days 1 to 20, followed by a $218 daily copay for days 21 to 70. Many supplemental benefits, such as home health services, fitness benefits, and preventive dental care, are available with no copay and no coinsurance.
Inpatient Hospital See details
Wellcare Dual Access Open (PPO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a copayment of $2,215 per stay for acute care and $2,080 per stay for psychiatric care. Prior authorization is required, and 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, outpatient substance abuse, and blood services—with no copay and a 20% coinsurance. Prior authorization is required for several of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Wellcare Dual Access Open (PPO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance, although 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, no copay, and prior authorization required. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Wellcare Dual Access Open (PPO D-SNP) partially covers emergency services, as worldwide emergency transportation is not covered. Emergency services have a $115 copay (waived if admitted within 24 hours) and no coinsurance, urgent care has a $40 copay and no coinsurance, and worldwide emergency and urgent services are covered up to $50,000 with a $115 copay and no coinsurance.
Primary Care See details
Wellcare Dual Access Open (PPO D-SNP) covers primary care, specialist, psychiatric, and therapy services with no copay and 20% coinsurance. Chiropractic services are partially covered with no copay or coinsurance for up to 12 routine visits per year (other chiropractic services are not covered), while podiatry services are not covered.
Preventive Services See details
Wellcare Dual Access Open (PPO D-SNP) provides partially covered preventive services, including annual physicals, fitness benefits, alternative therapies, and remote access technologies with no copay and no coinsurance. Covered kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome-visit EKGs have no copay and a 20% coinsurance. However, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, therapeutic massage, and in-home support.
Hearing Services See details
Hearing services are covered under the Wellcare Dual Access Open (PPO D-SNP) plan, featuring annual routine hearing exams with no copay and 20% coinsurance, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $1,000 per ear annually, though 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) offers partially covered vision services, providing one routine eye exam per year with no copay and a 20% coinsurance, though other eye exam services are not covered. Covered eyewear has no copay, except for contact lenses which require a 20% coinsurance, up to a $600 combined annual limit with prior authorization required.
Dental Services See details
Dental Services are partially covered by Wellcare Dual Access Open (PPO D-SNP), with Medicare-covered dental services requiring no copay and a 20% coinsurance. Other preventive and comprehensive dental benefits are offered with no copay and no coinsurance, though maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Dual Access Open (PPO D-SNP) with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Dual Access Open (PPO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Dual Access Open (PPO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for these benefits, 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 copay, subject to a minimum 20% coinsurance for lab services, diagnostic procedures, X-rays, and therapeutic radiological services. Prior authorization is required for all of these covered services.
Home Health Services See details
Home health services are covered under the Wellcare Dual Access Open (PPO D-SNP) plan 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, but some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, 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) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and 71 to 100, and a $218 daily copay for days 21 to 70, with no prior three-day hospital stay required for admission.
Other Services See details
Wellcare Dual Access Open (PPO D-SNP) partially covers other services, offering a meal benefit for chronic illnesses or homebound conditions 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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