A non-government entity
Wellcare Assist Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist Open (PPO) in 2026, please refer to our full plan details page.
Wellcare Assist Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in NC. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Assist 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 Assist 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 Assist Open (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $480.00 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 $9550.00 (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 $9550.00 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 Assist Open (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Assist Open (PPO) prescription drug plan features an annual drug deductible of $480. For Tier 6 select care drugs, you will pay no copay across all standard or preferred pharmacies and mail-order options. Generic medications in Tiers 1 and 2 are highly affordable, with preferred pharmacy copays starting at $18 and no copay for a 3-month supply when using preferred mail order. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copays. You will pay a 20% coinsurance for Tier 3 preferred brands, 32% coinsurance for Tier 4 non-preferred drugs, and 25% coinsurance for Tier 5 specialty drugs. Utilizing preferred pharmacies and preferred mail-order services can help you minimize your out-of-pocket prescription expenses.
Additional Benefits
The Wellcare Assist Open (PPO) plan offers robust medical coverage with no copay or coinsurance for primary care visits, annual physicals, and routine preventive services. For specialized care, members pay a low $15 copay for specialist visits and Medicare-covered dental services, while emergency room visits carry a $130 copay. Inpatient hospital stays require no coinsurance, though a daily copay of $325 applies for the first several days of acute and psychiatric stays. This plan also features extensive supplemental benefits, including no copay for routine dental, vision, and hearing exams, along with allowances for hearing aids and eyewear. Members can take advantage of up to 24 one-way trips to approved health locations and home health services with no copay or coinsurance. For durable medical equipment and dialysis services, there is no copay and a standard 20% coinsurance applies.
Inpatient Hospital See details
Wellcare Assist Open (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a daily copay of $325 for days 1 to 6 of acute stays and days 1 to 7 of psychiatric stays, with no copay for subsequent days up to day 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Assist Open (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services, a $130 to $300 copay per stay for observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse services require a $25 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Assist Open (PPO) covers partial hospitalization services with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Assist Open (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Wellcare Assist Open (PPO) covers emergency services with a $130 copay and urgently needed services with a $30 copay, both with no coinsurance and copays waived if admitted within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under Wellcare Assist Open (PPO) feature no copay and no coinsurance for primary care physician services, while specialist visits, physical therapy, occupational therapy, and podiatry services require a $15 copay and no coinsurance. Mental health and psychiatric services have a $25 copay and no coinsurance, telehealth services range from a $0 to $30 copay with no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Wellcare Assist Open (PPO) offers preventive services with no copay and no coinsurance for annual physicals, fitness programs, PERS, alternative therapies, remote access, and routine screenings, while kidney disease education has no copay and a 20% coinsurance. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, extra smoking cessation, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Wellcare Assist Open (PPO), which features a $15 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and hearing aid fittings. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Assist Open (PPO) partially covers vision services, featuring one annual routine eye exam with no copay and no coinsurance, while other eye exam services are not covered. Eyewear benefits, including contacts and eyeglasses, are also covered with no copay or coinsurance up to a $300 yearly maximum.
Dental Services See details
Wellcare Assist Open (PPO) partially covers dental services, offering Medicare-covered dental care for a $15 copay and no coinsurance, and other preventive and comprehensive services with no copay and no coinsurance up to a $2,000 yearly limit. Implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare Assist Open (PPO) with no copay, while Medicare Part B insulin drugs have a $35 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation, require no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Assist Open (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist 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 from specified manufacturers, while diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Assist Open (PPO) with prior authorization, featuring no coinsurance and a $0 to $50 copay for diagnostic tests, and no copay or coinsurance for lab services. Radiological services require a $45 copay with coinsurance for X-rays, a minimum 20% coinsurance with a copay for therapeutic radiology, and diagnostic radiology starting at no copay.
Home Health Services See details
Wellcare Assist 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 not covered in practice under Wellcare Assist Open (PPO), though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. These services carry no coinsurance and require copays ranging from $25 to $50.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Assist Open (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 51 through 100, a $218 daily copay for days 21 through 50, and additional days beyond the 100-day limit are not covered.
Other Services See details
Wellcare Assist Open (PPO) partially covers other services, offering over-the-counter (OTC) items and referral-based chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved