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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 AR. This plan received an overall rating of 3.5 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:
Sign up for Wellcare Simple Open (PPO)
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Drug Coverage
The Wellcare Simple Open (PPO) plan has a $420 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, preferred generic drugs have no copay at preferred or mail order pharmacies, and 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, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service. Emergency, primary care, and preventive services have copays, and hearing, vision, and dental services are also covered with varying copays. This plan provides additional coverage for services such as ambulance, mental health, and home health services, with no copays for many services, and coinsurance for others. There is also coverage for medical equipment, diagnostic services, and skilled nursing facilities, with specific copays and coinsurance amounts. Additionally, the plan covers OTC items and meal benefits, along with other services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care. For acute care, you will pay a \$350 copay for days 1-6, and no copay for days 7-90. For psychiatric care, you will pay a \$300 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services for the Wellcare Simple Open (PPO) plan include coverage for Outpatient Hospital Services with a copay between $0 and $375, Observation Services with a copay between $125 and $375, and Ambulatory Surgical Center (ASC) Services with a $300 copay. This plan also covers Individual and Group Sessions for Outpatient Substance Abuse with a copay of $40, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple Open (PPO) plan, but requires prior authorization. The copay for this benefit is $105.
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 $300 copay, and there is no coinsurance; however, Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Coverage, are covered by the Wellcare Simple Open (PPO) plan. Emergency Services have a $125 copay, and Urgent Services have a $45 copay, both with 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, and Occupational Therapy Services with a $35 copay. This plan also covers Physician Specialist Services with a $25 copay, and Physical Therapy and Speech-Language Pathology Services with a $35 copay. Mental Health Specialty Services and Psychiatric Services have a $40 copay for individual and group sessions, and Opioid Treatment Program Services have a $25 copay.
Preventive Services See details
Preventive Services, including annual physical exams, are covered by the Wellcare Simple Open (PPO) plan with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services such as Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit have no copay.
Hearing Services See details
Hearing exams have a $25 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered with a maximum benefit of $500 per ear every year, and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Wellcare Simple Open (PPO) covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, and there is a combined maximum benefit of $300 per year for eyewear.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $25 copay, oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, fluoride treatment with no copay, other preventive dental services with no copay, restorative services with no copay, adjunctive general services with no copay, endodontics with no copay, periodontics with no copay, prosthodontics (removable) with no copay, prosthodontics (fixed) with no copay, and oral and maxillofacial surgery with no copay. Orthodontic Services are covered up to a maximum of $1500 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
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
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Wellcare Simple Open (PPO) plan. DME has a 20% coinsurance, while Prosthetics and Medical Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $45, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $275, and Outpatient X-Ray Services have a copay of $75. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered under the Wellcare 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 Simple Open (PPO) plan, but the specific services listed are not covered. The plan does not specify the copay or coinsurance for the services that are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Open (PPO) plan, but require prior authorization. For days 1-20 and 51-100, there is no copay, and for days 21-50, the copay is $214.
Other Services See details
The Wellcare Simple Open (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit of $116 every three months. Meal Benefits are covered with no copay and require a doctor's referral. 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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