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Wellcare Dual Access Sync Open (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access Sync 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 Sync Open (PPO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access Sync 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 NE. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Dual Access Sync 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 Sync 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 Sync 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 Sync Open (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.30. 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 $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 Sync Open (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For maximum savings, members pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using preferred pharmacies or preferred mail order services. If you choose standard pharmacies, copayments start at $19 for Tier 1 and $20 for Tier 2 drugs. For higher-tier medications, Tier 3 preferred brands require an 18% coinsurance regardless of the pharmacy type you use. Tier 4 non-preferred drugs carry a $100 copay for a one-month supply, while Tier 5 specialty tier drugs require a 25% coinsurance for a one-month supply.
Additional Benefits
The Wellcare Dual Access Sync Open (PPO D-SNP) plan offers comprehensive coverage for medical services, generally requiring no copay but featuring a 20% coinsurance for outpatient care, doctor visits, diagnostic tests, and medical equipment. Inpatient hospital stays require an $1,890 copay per admission with no coinsurance, while skilled nursing facility care features no copay for days 1 to 20 and 71 to 100. Supplemental benefits like home health services, meals, over-the-counter items, and up to 36 annual transportation trips are covered with no copay and no coinsurance. Routine dental, vision, and hearing exams are available with no copay and a 20% coinsurance, while allowances for hearing aids, eyewear, and preventive dental care feature no copay and no coinsurance.
Inpatient Hospital See details
Wellcare Dual Access Sync Open (PPO D-SNP) provides partially covered inpatient hospital services, which require a $1,890 copayment per admission or stay and no coinsurance for acute and psychiatric care. Prior authorization is required for these services, and additional hospital days, non-Medicare-covered stays, and acute upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Dual Access Sync Open (PPO D-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Dual Access Sync Open (PPO D-SNP) plan with no copay and a 20% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers ambulance services with a 20% coinsurance and no copay for both ground and air transportation. Transportation services are partially covered with no copay and no coinsurance, providing up to 36 one-way trips per year to plan-approved health-related locations, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Wellcare Dual Access Sync Open (PPO D-SNP) with a $115 copay and no coinsurance, and urgently needed services are covered with a $40 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 limit with a $115 copay and no coinsurance for emergency and urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under Wellcare Dual Access Sync Open (PPO D-SNP) are covered with no copay and 20% coinsurance for primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services. Telehealth benefits are also covered with a $0.00 to $40.00 copay and 20% coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) partially covers preventive services, offering annual physicals, fitness benefits, personal emergency response systems, alternative therapies, in-home support, and remote access with no copay and no coinsurance, while kidney education and screenings carry no copay and a 20% coinsurance. Sub-services not covered under this benefit include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers annual routine hearing exams with no copay and a 20% coinsurance, alongside fitting evaluations with no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear annually, though over-the-counter (OTC), inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) vision services are partially covered with no deductible, providing one routine eye exam per year with no copay and 20% coinsurance, though other eye exam services are not covered. Eyewear is covered up to a $300 combined annual limit, featuring contact lenses with no copay and 20% coinsurance, and eyeglasses, lenses, frames, and upgrades with no copay and no coinsurance.
Dental Services See details
Dental services are partially covered by Wellcare Dual Access Sync Open (PPO D-SNP), offering Medicare-covered dental care with no copay and 20% coinsurance, and preventive and select comprehensive services with no copay and no coinsurance up to a $1,500 annual limit. While many services are covered, fixed and removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Dual Access Sync Open (PPO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required. This benefit covers durable medical equipment, medical supplies, prosthetics, and diabetic equipment, with diabetic supplies limited to specific manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Dual Access Sync Open (PPO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. Covered services include outpatient diagnostic tests, lab work, therapeutic and diagnostic radiology, and outpatient X-rays.
Home Health Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Wellcare Dual Access Sync Open (PPO D-SNP) with no copay, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access Sync Open (PPO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization, but additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and days 71 to 100, while a $218 daily copay applies for days 21 to 70.
Other Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) partially covers other services, featuring over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The meal benefit requires a referral for certain medical conditions, and OTC items are eligible for reimbursement.
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