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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 2026, 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 2026.
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 $50.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $260.00 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 Giveback Open (PPO) prescription drug plan features an annual drug deductible of $615. Under this plan, you will enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when utilizing a preferred pharmacy. Standard pharmacy and standard mail order options are also available for generic drugs with copays ranging from $5 to $30. Brand-name and specialty medications require coinsurance instead of copays, with Tier 3 preferred brands and Tier 5 specialty drugs requiring a 25% coinsurance. Tier 4 non-preferred drugs carry a 35% coinsurance at preferred pharmacies and a 36% coinsurance at standard pharmacies. Understanding these cost-sharing tiers ensures you can accurately plan your healthcare budget with this Wellcare PPO plan.
Additional Benefits
The Wellcare Giveback Open (PPO) plan offers coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, select telehealth, and home health care. For inpatient hospital stays, members pay no coinsurance, though acute stays require a $725 daily copay for the first three days, followed by no copay for days four through ninety. Emergency room visits carry a $115 copay, while specialist visits require a $35 copay with no coinsurance. Routine vision and hearing exams, along with preventive dental care, are covered with no copay, and eyewear is covered with no copay up to a $100 annual limit. Comprehensive dental services and hearing aids are not covered by this plan. Diagnostic lab work features no copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Wellcare Giveback Open (PPO) with no coinsurance, requiring a daily copay of $725 for days 1 through 3 for acute stays and $675 for days 1 through 3 for psychiatric stays, with no copay for days 4 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Giveback Open (PPO) covers outpatient hospital services with a copay ranging from no copay up to $500 and 30% coinsurance, and observation services with a $115 copay per stay and 30% coinsurance. Ambulatory surgical center services require a $475 copay and no coinsurance, outpatient substance abuse sessions have a $35 copay and no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Giveback Open (PPO) with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Giveback Open (PPO) covers ground and air ambulance services with a $330 copay per service and no coinsurance, though prior authorization is required. Some transportation services are covered, but trips to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Wellcare Giveback Open (PPO) covers emergency services with a $115 copay and no coinsurance, and urgent care with a $40 copay and no coinsurance, with copays waived if admitted within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback Open (PPO) offers primary care physician services and select telehealth benefits with no copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, and mental health services require a $35 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Wellcare Giveback Open (PPO) are partially covered, offering annual physical exams, alternative therapies, memory fitness, and remote access technologies with no copay and no coinsurance, while kidney disease education requires no copay and a 20% coinsurance. Supplemental sub-services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Giveback Open (PPO) covers Medicare-covered hearing exams with a $35 copay and no coinsurance, alongside one routine exam and one fitting evaluation annually with no copay and no coinsurance. There is no deductible for these services, though prescription and over-the-counter hearing aids are not covered.
Vision Services See details
Wellcare Giveback Open (PPO) vision services are covered with no coinsurance, no deductibles, and require prior authorization. Routine eye exams are covered with no copay once per year, though other eye exam services are not covered. Eyewear, including lenses, frames, and contacts, is also covered with no copay up to a combined maximum benefit of $100 annually.
Dental Services See details
Dental services are partially covered by Wellcare Giveback Open (PPO), featuring Medicare-covered dental with a $35.00 copay and no coinsurance, and preventive services with no copay and no coinsurance. Restorative services, endodontics, periodontics, removable and fixed prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Giveback Open (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this plan, 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
Dialysis Services are covered by the Wellcare Giveback Open (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Giveback Open (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Giveback Open (PPO) covers diagnostic and radiological services, offering lab services and diagnostic radiology with no copay and no coinsurance. Diagnostic tests require a copay between $0 and $75 with no coinsurance, while outpatient X-rays have a $50 copay and therapeutic radiology requires a 20% coinsurance with no copay.
Home Health Services See details
Wellcare Giveback Open (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Giveback Open (PPO) provides cardiac rehabilitation services with no coinsurance, and while some services are covered, standard cardiac rehabilitation ($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 Giveback Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though this benefit is partially covered as additional days beyond the standard Medicare limit are not covered. Prior authorization is required, and there is no copay for days 1 to 20 and days 71 to 100, while days 21 to 70 require a $175 daily copay.
Other Services See details
Other Services are not covered under the Wellcare Giveback Open (PPO), as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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