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Wellcare Assist Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist Open (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Assist Open (PPO) is a PPO plan offered by Nebraska Total Care, Inc. available for the 2026 plan year 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 Assist 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 Assist 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 Assist Open (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.80. 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 $570.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4800.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4800.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $7100.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 Assist Open (PPO) prescription drug plan features an annual drug deductible of $570. For Tier 1 preferred generic and Tier 2 generic medications, one-month copays start as low as $18 at preferred pharmacies, and you will pay no copay for a three-month supply filled through preferred mail order. Additionally, Tier 6 select care drugs are fully covered with no copay across all pharmacies and mail-order options. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands require 20% coinsurance, Tier 4 non-preferred drugs require 32% coinsurance, and Tier 5 specialty drugs require 25% coinsurance for a one-month supply. These coinsurance rates remain consistent whether you use a preferred or standard pharmacy, or order through the mail.
Additional Benefits
The Wellcare Assist Open (PPO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care provider visits, routine preventive care, and home health services. For specialized medical needs, members can expect predictable costs, including a $20 to $25 copay for specialist visits, a $130 copay for emergency services, and a $325 daily copay for the first seven days of an inpatient hospital stay. Most outpatient services, diagnostic tests, and skilled nursing care also feature no coinsurance, keeping out-of-pocket costs manageable. Additionally, the plan provides excellent everyday wellness benefits, including routine dental, vision, and hearing services with no copays and generous annual allowances for eyewear, hearing aids, and comprehensive dental care. Members also enjoy practical extras like no-copay over-the-counter items and up to 24 free one-way trips to plan-approved health locations. While many services carry no coinsurance, certain specialized needs such as durable medical equipment and dialysis require a standard 20% coinsurance.
Inpatient Hospital See details
Wellcare Assist Open (PPO) covers inpatient acute hospital stays with no coinsurance and a $325 daily copay for days 1 to 7 (no copay for days 8 to 90), and psychiatric stays with no coinsurance and a $275 daily copay for days 1 to 7 (no copay for days 8 to 90). Prior authorization is required, and these benefits are partially covered as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Assist Open (PPO) covers outpatient services with no coinsurance, featuring a no-copay to $300 copay for outpatient hospital services and a $130 to $300 copay per stay for observation services. Ambulatory surgical center services require a $200 copay with no coinsurance, outpatient substance abuse sessions carry a $25 copay with no coinsurance, and outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the Wellcare Assist Open (PPO) plan with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Assist Open (PPO) covers ambulance and transportation services, offering ground and air ambulance rides for a $300 copay per service with no coinsurance. The plan also provides up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Assist Open (PPO) covers emergency services with a $130 copay and urgently needed services with a $40 copay, both featuring no coinsurance and cost-sharing that does not count toward the deductible. Worldwide emergency and urgent care are partially covered up to $50,000 with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under Wellcare Assist Open (PPO) feature no copay and no coinsurance for primary care provider visits, while specialist visits, physical therapy, and mental health services require copays ranging from $20 to $25 with no coinsurance. Chiropractic and podiatry services are not covered, but additional telehealth benefits are available with copays ranging from no copay to $40 and no coinsurance.
Preventive Services See details
Wellcare Assist Open (PPO) provides partially covered preventive services with no copay and no coinsurance for annual physical exams, fitness benefits, PERS, alternative therapies, and other screenings. Kidney disease education has no copay and a 20% coinsurance, but several services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Wellcare Assist Open (PPO) covers Medicare-covered hearing exams with a $20 copay and no coinsurance, plus annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual limit per ear, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Wellcare Assist Open (PPO) provides partially covered vision services with no coinsurance and no copays for routine eye exams and eyewear, though prior authorization is required and other eye exam services are not covered. Covered eyewear, including contact lenses, eyeglasses, and upgrades, has a $300 combined annual maximum.
Dental Services See details
Dental services are partially covered by Wellcare Assist Open (PPO), with Medicare-covered dental requiring a $20 copay and no coinsurance, and other covered preventive and comprehensive services offering no copay and no coinsurance. While many comprehensive services are covered up to a $3,000 annual maximum, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Assist Open (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Assist Open (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment benefits under Wellcare Assist Open (PPO) are covered with prior authorization, requiring no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic supplies. Diabetic therapeutic shoes or inserts also require a 20% coinsurance, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Assist Open (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $40 copay for diagnostic procedures and tests. Radiological services require a $25 copay and coinsurance for outpatient X-rays, a copay and minimum 20% coinsurance for therapeutic radiology, and a copay starting at $0 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Wellcare Assist Open (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under Wellcare Assist Open (PPO) with no coinsurance, but only some services are covered in practice. Specifically, cardiac rehabilitation (carrying a $40 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellcare Assist Open (PPO) with no coinsurance, featuring no copay for days 1 to 20 and 51 to 100, and a $218 copay for days 21 to 50. Prior authorization is required, a prior three-day hospital stay is not required before admission, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Assist Open (PPO) provides coverage for select other services, including over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this benefit.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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