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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 2025, 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 2025.
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 $250.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $13300.00 (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 $13300.00 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 has a $420 deductible for prescription drugs. After the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic and specialty drugs, there is no copay at preferred pharmacies. For standard generic drugs, you will pay 25% coinsurance, and for preferred brand drugs, you will pay 39% coinsurance at preferred pharmacies.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers coverage for a variety of healthcare services. Inpatient hospital stays have a copay, with no copay for days 4-90, while outpatient services have a mix of copays and coinsurance. The plan includes coverage for emergency services, primary care, preventive services, and hearing, vision, and dental services, with varying copays and no copays for some services. Additional benefits include ambulance services, home health services, and medical equipment with coinsurance or no copay. The plan also provides coverage for home infusion, dialysis, and skilled nursing facility services, but may require prior authorization or have copays. Other services like over-the-counter items and a meal benefit are included with no copay, while certain services like acupuncture, private duty nursing, and others are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $615 copay for days 1-3 and no copay for days 4-90 for acute care, and a $675 copay for days 1-3 and no copay for days 4-90 for psychiatric care. Additional days for inpatient hospital-acute, non-Medicare-covered stays for inpatient hospital-acute, upgrades for inpatient hospital-acute, additional days for inpatient hospital psychiatric, and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, with a 30% coinsurance and a copay between $0 and $500, and observation services, with a 30% coinsurance and a $110 copay. Ambulatory Surgical Center (ASC) services have a $250 copay. Outpatient substance abuse services include individual and group sessions with a copay between $35 and $35. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple Open (PPO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple Open (PPO) plan. Ground and air ambulance services have a $300 copay, with no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered under the Wellcare Simple Open (PPO) plan, with a $110 copay and no coinsurance, and the copay is waived if admitted to the hospital within 24 hours. Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $15 copay. Occupational Therapy Services, Physician Specialist Services, Medicare-covered individual and group mental health sessions, individual and group psychiatric sessions, and Physical Therapy and Speech-Language Pathology Services all have copays ranging from $30-$35. Additional Telehealth benefits have a copay between $0 and $40, and Opioid Treatment Program Services have a $30 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services are covered, including Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Kidney disease education services have a 20% coinsurance. Additional preventive services such as health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, counseling services, are not covered. Alternative therapies, fitness benefits, and remote access technologies (including web/phone-based technologies and nursing hotline) are covered with no copay.
Hearing Services See details
Hearing Exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to $350 per ear annually with no copay for prescription hearing aids (all types); however, prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$30, while routine eye exams have no copay. Eyewear has no copay, with a combined maximum plan benefit of $100 per year for both in-network and out-of-network services.
Dental Services See details
Dental Services include Medicare dental services with a $30 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay. Orthodontic Services are covered up to a maximum of $1,000 per year. Prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple Open (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Simple Open (PPO) plan, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medicare-covered Medical Supplies, and no copay. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic procedures/tests have a copay between $0 and $50, lab services have no copay, and diagnostic radiological services have a copay up to $500.00. 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 Simple Open (PPO) plan with no 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 Simple Open (PPO) plan. However, the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Open (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, but for days 21-60, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the Wellcare Simple Open (PPO) plan, 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. Over-the-Counter (OTC) Items are covered with no copay, and the plan offers a meal benefit with no copay that requires a doctor's referral.
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