A non-government entity
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 NE. This plan received an overall rating of 3 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 $9000.00 (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 $9000.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple Open (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 select care drugs are covered with no copay across all standard and preferred pharmacies. For higher-tier medications, costs transition to coinsurance, with Tier 3 preferred brands and Tier 5 specialty drugs requiring a 25% coinsurance. Tier 4 non-preferred drugs have a 38% coinsurance at preferred pharmacies and a 39% coinsurance at standard pharmacies. These structured costs help you budget effectively for your medication needs throughout the plan year.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialized care, members pay a $40 copay for specialists, physical therapy, and occupational therapy, while inpatient hospital stays require daily copays for the first seven days before transitioning to no copay. Emergency care carries a $130 copay, and outpatient services generally range from no copay up to a $500 copay depending on the treatment. Routine dental, vision, and hearing exams are covered with no copay, alongside allowances of up to $100 for eyewear and $500 per ear for prescription hearing aids. Comprehensive dental services are covered with a 40% coinsurance up to a $1,000 annual limit, while dialysis and durable medical equipment require a 20% coinsurance with no copay. Skilled nursing facility stays are also covered, featuring no copay for days 1 to 20 and days 61 to 100.
Inpatient Hospital See details
Wellcare Simple Open (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $400 daily copay for acute days 1 to 7 and a $325 daily copay for psychiatric days 1 to 7, followed by no copay for days 8 to 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under the Wellcare Simple Open (PPO) with no coinsurance, though copayments apply and prior authorization may be required for certain treatments. Under this plan, outpatient hospital services carry a $0 to $500 copay ($130 to $500 for observation services), ambulatory surgical center services require a $300 copay, outpatient substance abuse sessions cost a $25 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Wellcare Simple Open (PPO) covers partial hospitalization services with a $140.00 copayment and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple Open (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered under this plan.
Emergency Services See details
Wellcare Simple Open (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, both waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple Open (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $40 copay and no coinsurance. Mental health and psychiatric services have a $25 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Simple Open (PPO) provides partially covered preventive services, including annual physical exams, fitness benefits, alternative therapies, and remote access technologies with no copays and no coinsurance. Kidney disease education is available with no copay and a 20% coinsurance, though several supplemental benefits like health education, in-home safety assessments, and nutritional services are not covered.
Hearing Services See details
Wellcare Simple Open (PPO) offers partially covered hearing services with no deductible, featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Wellcare Simple Open (PPO) partially covers vision services with no coinsurance and no deductible, though other eye exam services are not covered. Routine eye exams (one per year) and eyewear—including contacts, lenses, and frames up to a $100 annual limit—are available with no copay, while other eye exams have a copay of up to $40.
Dental Services See details
Wellcare Simple Open (PPO) covers Medicare-covered dental services for a $40 copay and no coinsurance, and preventive dental services with no copay and no coinsurance. Comprehensive dental benefits are partially covered with no copay and a 40% coinsurance up to a $1,000 annual maximum, excluding removable prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Wellcare Simple Open (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from 0% to 20%, while Medicare Part B insulin has a $35.00 copay and no coinsurance.
Dialysis Services See details
Wellcare Simple Open (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple Open (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic therapeutic shoes, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay, though they are limited to specified manufacturers and prior authorization is required for most equipment.
Diagnostic and Radiological Services See details
Wellcare Simple Open (PPO) covers diagnostic and radiological services with no coinsurance and a $0 to $40 copay for diagnostic tests, alongside no copay for lab and diagnostic radiology services. Outpatient X-rays require a $50 copay, and therapeutic radiology services carry a 20% coinsurance, with prior authorization required for all services.
Home Health Services See details
Home Health Services are covered by Wellcare Simple Open (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Wellcare Simple Open (PPO) with no coinsurance, but only some services are covered in practice. Standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation (with a $50 copay), pulmonary rehabilitation (with a $35 copay), and supervised exercise therapy for peripheral artery disease (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 61 to 100, and a $218 copay for days 21 to 60. Prior authorization is required, and while a prior three-day hospital stay is not needed before admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Simple Open (PPO), which features a chronic illness meal benefit with no copay and no coinsurance, though a referral is required. Acupuncture and over-the-counter (OTC) items are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved