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Wellcare Giveback Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Giveback 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 Giveback 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 Giveback 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 Giveback 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. Additionally, this plan comes with a Part B Premium reduction of $63.60. You must continue to pay paying your reduced 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 Giveback Open (PPO) plan has a $420 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have no copay at preferred pharmacies and a $10 copay at standard pharmacies. The plan covers drugs in the initial coverage phase until your total drug costs reach $2,000. Once you reach this amount, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Giveback Open (PPO) plan offers comprehensive coverage with a variety of benefits. It includes coverage for inpatient hospital stays with a copay, as well as outpatient services, emergency care, and primary care visits, often with no copay. Preventive, hearing, vision, and dental services are also covered with varying copays or no copays, and the plan provides coverage for home health, skilled nursing, and medical equipment. Additional benefits include coverage for ambulance services, home infusion, dialysis, and some diagnostic and radiological services.
Inpatient Hospital See details
Inpatient hospital services are covered, with a copay of $725 for days 1-3 and no copay for days 4-90 for acute care, and a copay of $675 for days 1-3 and no copay for days 4-90 for psychiatric care. Additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a 30% coinsurance and a copay between $0 and $500, and Observation Services have a 30% coinsurance and a $110 copay. Ambulatory Surgical Center Services have a $475 copay, and 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 by the Wellcare Giveback Open (PPO) plan. The plan has an $80 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a $300 copay, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Wellcare Giveback Open (PPO) plan with a $110 copay and no coinsurance. Urgently Needed Services have a $40 copay and no coinsurance, while Worldwide Emergency Services have a $110 copay and no coinsurance for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Giveback Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and mental health specialty services with a $35 copay. The plan also covers other health care professional services with a copay between $0 and $35, psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $35 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 additional services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance. Health Education, In-Home Safety Assessment, Personal Emergency Response System (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 Benefit, 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, and Counseling Services are not covered. Fitness Benefit and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) have no copay. Alternative Therapies has no copay.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Giveback Open (PPO) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with no copay, with a combined maximum benefit of $100 per year. Routine eye exams are covered with no copay, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay.
Dental Services See details
The Wellcare Giveback Open (PPO) plan covers Medicare dental services with a $35 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventative dental services are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Giveback Open (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Wellcare Giveback Open (PPO) plan covers medical equipment with a 20% coinsurance for Durable Medical Equipment and Prosthetic Devices. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a minimum copay of $0 for Diagnostic Procedures/Tests, and a $0 copay for Lab Services. Diagnostic Radiological Services have a maximum copay of $500, while Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback 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 Giveback Open (PPO) plan, but the plan does not cover any of the sub-services. The plan has a copay for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20 and days 61-100, but there is a $197 copay for days 21-60. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include a meal benefit with a $0 copay, but acupuncture, over-the-counter items, Dual Eligible SNPs, 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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