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Wellcare Complete Simple Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Complete 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 Complete Simple Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Complete Simple Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellcare Complete 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 Complete 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 Complete 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 $5450.00 (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 $5450.00 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 Complete Simple Open (PPO)
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Drug Coverage
The Wellcare Complete Simple Open (PPO) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay the following costs for your prescriptions. For preferred generic drugs, you will have no copay at preferred pharmacies or through mail order, and a $10 copay at standard pharmacies. Standard generic drugs have 25% coinsurance, while preferred brand drugs have either 43% or 44% coinsurance depending on the pharmacy. Non-preferred drugs have 28% coinsurance, and specialty tier drugs have no copay. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Wellcare Complete Simple Open (PPO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have copays, with no copay for many days, while outpatient services and emergency services also have copays. Primary care visits are covered with no copay, and there is no copay for many preventive, hearing, and vision services. Dental services, including oral exams, x-rays, and other treatments, are covered with no copay, but orthodontics are not covered. Home health services have a copay, and skilled nursing facilities also have copays. The plan also covers ambulance and transportation services, with a copay for ambulance and no copay for some transportation services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $350 copay for days 1-6 and no copay for days 7-90, while additional days (91-999) have no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you'll pay a $400 copay for days 1-5 and no copay for days 6-90, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $425, and observation services with copays between $140 and $425. Ambulatory Surgical Center (ASC) Services have a $250 copay, while individual and group sessions for outpatient substance abuse have a $35 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Complete Simple Open (PPO) plan, but requires prior authorization. You will have a $130 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Complete Simple Open (PPO) plan. Ground and Air Ambulance Services have a $270 copay, and Transportation Services to a plan-approved health-related location have no copay for up to 12 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $140, $40, and $140, respectively, with no coinsurance. Worldwide Urgent Coverage also has a $140 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Complete 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. The plan also covers physician specialist services with a $30 copay and mental health specialty services with a $35 copay for individual and group sessions. Podiatry services and other health care professional visits have a copay between $0 and $30, and physical therapy and speech-language pathology services have a $35 copay. The plan covers additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with a $30 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and other preventive services with a $0 copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additionally, there is a 20% coinsurance for Kidney Disease Education Services.
Hearing Services See details
Hearing exams are covered with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered, with no copay. Prescription hearing aids are covered up to $500 per ear every year, but 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
Vision services include eye exams with a copay of $0-$30, and eyewear with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay, and a combined maximum benefit of $200 every year.
Dental Services See details
The Wellcare Complete Simple Open (PPO) plan covers Medicare Dental Services with a $30 copay, and other dental services including oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, other preventative services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Complete Simple Open (PPO) plan. The plan has a $35 copay for Medicare Part B insulin drugs, and a coinsurance between 0-20% for both Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Complete Simple Open (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Wellcare Complete Simple Open (PPO) plan. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, and Radiological Services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Complete Simple Open (PPO) plan with a $50 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 Complete Simple Open (PPO) plan. However, intensive cardiac rehabilitation services, pulmonary rehabilitation services, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Complete Simple Open (PPO) plan, but require prior authorization. For days 1-20 and days 41-100, there is no copay, but for days 21-40, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes over-the-counter items and meal benefits, with no copay for either. 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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