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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 2026, 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 2026.
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 $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 $10100.00 (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 $10100.00 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 Simple Open (PPO) plan features an Enhanced Alternative drug benefit with a $615.00 annual prescription drug deductible. After meeting this deductible, you enter the initial coverage phase with no copay for Tier 1 preferred generics at preferred pharmacies, or a $10.00 copay at standard pharmacies. Tier 5 specialty drugs also feature no copay at both pharmacy types, while other tiers require coinsurance ranging from 25% to 37%. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, beneficiaries who qualify for the low-income subsidy can receive a premium reduction down to $0.00.
Additional Benefits
Wellcare Simple Open (PPO) offers comprehensive medical coverage with no copay for primary care visits, annual physicals, routine vision and hearing exams, and home health services. For specialized care, members pay predictable copays with no coinsurance, including a $25 copay for specialists and a $130 copay for emergency services. Inpatient hospital stays require daily copays for the first few days, after which there is no copay, while most outpatient services feature no coinsurance and variable copays. The plan also includes robust dental, vision, and hearing benefits, featuring no copays for routine dental care up to a $2,000 annual maximum and a $300 allowance for eyewear. For specialized medical needs, dialysis and durable medical equipment require a 20% coinsurance with no copay, while diabetic supplies are available with no copay and no coinsurance. Skilled nursing facility stays are also covered with no copay for the first 20 days, ensuring affordable recovery support.
Inpatient Hospital See details
Wellcare Simple Open (PPO) partially covers inpatient hospital benefits with no coinsurance, though prior authorization is required. Acute hospital stays require a $350 daily copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays require a $300 daily copay for days 1 through 5 and no copay for days 6 through 90. Upgrades, additional days, and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services covered under Wellcare Simple Open (PPO) require no coinsurance, with copays ranging from $0 to $375 depending on the specific service. Covered benefits include outpatient hospital and observation services, ambulatory surgical center visits for a $300 copay, outpatient substance abuse sessions for a $40 copay, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Wellcare Simple Open (PPO) plan with a $140.00 copay and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Wellcare Simple Open (PPO) partially covers Ambulance and Transportation Services, offering ground and air ambulance services with a $300 copay and no coinsurance. However, transportation services to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
Wellcare Simple Open (PPO) covers emergency services with a $130 copay and urgently needed services with a $45 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered with a $130 copay and no coinsurance up to a $50,000 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple Open (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Physical, occupational, and speech therapy services are available with a $35 copay and no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Wellcare Simple Open (PPO), offering annual physicals, fitness benefits, and glaucoma screenings with no copays and no coinsurance. Kidney disease education is covered with a 20% coinsurance and no copay, but several sub-services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Simple Open (PPO) partially covers hearing services, excluding OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids. Covered routine exams, fittings, and prescription hearing aids (up to $500 per ear annually) have no copay, while Medicare-covered exams require a $25 copay, all with no coinsurance.
Vision Services See details
Wellcare Simple Open (PPO) covers vision services with no coinsurance, offering one routine eye exam per year with no copay and other eye exams for a $0 to $25 copay. Eyewear, including contact lenses and eyeglasses, is covered with no copay and features a combined annual maximum benefit of $300.
Dental Services See details
Wellcare Simple Open (PPO) dental benefits are partially covered, with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Medicare-covered dental services require a $25 copay and no coinsurance, while other covered preventive and comprehensive dental services are available with no copay and no coinsurance up to a $2,000 annual maximum.
Home Infusion bundled Services See details
Wellcare Simple Open (PPO) covers Home Infusion bundled Services, which require prior authorization and may involve step therapy. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple Open (PPO) plan with a 20% coinsurance and no copay. This coverage ensures access to vital renal care therapies while maintaining a clear and consistent cost-sharing structure.
Medical Equipment See details
Wellcare Simple Open (PPO) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple Open (PPO) with prior authorization, featuring no copay or coinsurance for lab services and up to a $45 copay with no coinsurance for diagnostic tests. Outpatient X-rays require a $50 copay and diagnostic radiology has a copay up to $275, both with no coinsurance, while therapeutic radiology requires up to 20% coinsurance with no copay.
Home Health Services See details
Wellcare Simple Open (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Simple Open (PPO) plan, meaning there are no copayments or coinsurance benefits available for these treatments. This lack of coverage applies to all related sub-services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Wellcare Simple Open (PPO) partially covers Skilled Nursing Facility (SNF) services with prior authorization, featuring no copay for days 1 to 20 and days 51 to 100, a $218 daily copay for days 21 to 50, and no coinsurance. Additional days beyond Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are partially covered by Wellcare Simple Open (PPO), which offers covered over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture and dual eligible SNPs with highly integrated services are not covered under this plan.
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