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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 All counties in CT. 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 has a $275.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 Simple Open (PPO) plan features an annual prescription drug deductible of $615. Beneficiaries can save on medication costs with no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or preferred mail order service. Additionally, Tier 6 select care drugs are covered with no copay at all participating pharmacies. For brand-name and specialty medications, costs are structured as coinsurance. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 35% coinsurance. Standard pharmacies and standard mail delivery are also available for Tier 1 and Tier 2 generics, with copays ranging from $5 to $30.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers robust coverage for everyday healthcare needs, featuring no copay for primary care visits, annual physicals, and preventive dental and vision services. Specialist visits require a $30 copay, while inpatient hospital stays require a copay of $650 per day for the first three days of an acute stay, followed by no copay for days four through 90. Outpatient services generally involve a 30% coinsurance along with copays ranging up to $500, depending on the specific service. For emergency care, members pay a $115 copay with no coinsurance, which is waived if admitted within 24 hours. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, while skilled nursing facility stays feature no copay for days 1 through 20. Please note that this plan does not cover routine transportation, prescription hearing aids, restorative dental services, or supplemental benefits like over-the-counter items.
Inpatient Hospital See details
Wellcare Simple Open (PPO) partially covers inpatient hospital care with no coinsurance, requiring a $650 copay for days 1 to 3 of an acute stay and a $675 copay for days 1 to 3 of a psychiatric stay, followed by no copay for days 4 to 90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple Open (PPO) covers outpatient hospital services with a 30% coinsurance and a copay ranging from no copay to $500, and observation services with a $115 copay per stay and 30% coinsurance. Ambulatory surgical center services require a $400 copay and no coinsurance, outpatient substance abuse sessions carry a $35 copay and no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Simple Open (PPO) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Wellcare Simple Open (PPO), which features a $325 copay and no coinsurance for ground and air ambulance services, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Wellcare Simple Open (PPO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted within 24 hours. Worldwide emergency and urgent care are partially covered up to $50,000 with a $115 copay and no coinsurance, 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 $30 copay and no coinsurance. While physical, occupational, and mental health therapies require a $35 copay and no coinsurance, podiatry is not covered, and for chiropractic care, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Wellcare Simple Open (PPO) are partially covered, featuring no copay and no coinsurance for annual physicals, memory fitness, remote access, and most screenings, though kidney disease education requires a 20% coinsurance and no copay. Several supplemental services, including health education, weight management, and nutritional benefits, are not covered by the plan.
Hearing Services See details
Hearing services are covered by Wellcare Simple Open (PPO), which features a $30 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. While some hearing aid services are covered, prescription hearing aids—including inner ear, outer ear, and over the ear types—and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Wellcare Simple Open (PPO) with no deductibles and no coinsurance, featuring no copay for annual routine eye exams and eyewear, though other eye exam services are not covered. Covered eyewear options like contact lenses and eyeglasses have no copay and are subject to a combined annual maximum benefit of $100.
Dental Services See details
Dental services are partially covered under the Wellcare Simple Open (PPO) plan, featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive services like exams, cleanings, and x-rays. Although adjunctive general services are covered with no copay and no coinsurance, the plan does not cover restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Wellcare Simple Open (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% (no coinsurance) to 20%.
Dialysis Services See details
Dialysis services are covered by the Wellcare Simple Open (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple Open (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance, while diabetic therapeutic shoes or inserts are covered with no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Simple Open (PPO) covers diagnostic and radiological services with no coinsurance and no copay for lab services, and diagnostic procedures ranging from no copay up to a $75 copay. Diagnostic radiological services have a minimum of no copay, outpatient x-rays carry a $50 copay, and therapeutic radiological services require a minimum 20% coinsurance.
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 covered by Wellcare Simple Open (PPO) with no coinsurance, though some services are not covered. Specifically, standard cardiac rehabilitation (which has a $30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for PAD ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and days 71 to 100, and a $218 copay for days 21 to 70. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple Open (PPO) does not provide coverage for Other Services, meaning supplemental benefits like acupuncture, over-the-counter (OTC) items, and meals are not covered.
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