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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 2025, 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 2025.
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 $32.20. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $500.00 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:
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Drug Coverage
The Wellcare Assist Open (PPO) plan has a $500 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $19 or $20 copay, while standard generic drugs have 23% coinsurance. Preferred brand drugs have a $100 copay, and non-preferred drugs have 25% coinsurance. Specialty tier drugs have no copay.
Additional Benefits
The Wellcare Assist Open (PPO) plan offers a variety of benefits with varying costs. You can expect to pay copays for inpatient hospital stays, outpatient services, and emergency services, while many primary care, preventive, and dental services have no copay. The plan also includes coverage for hearing, vision, and home health services. Additional benefits include ambulance and transportation services, and other services like over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $325 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you'll pay a $325 copay for days 1-7, and no copay for days 8-90. Additional days and non-medicare covered stays for both are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $300, Observation Services with a copay between $125 and $300, Ambulatory Surgical Center (ASC) Services with a $200 copay, and Outpatient Substance Abuse Services with a $25 copay per individual or group session. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist Open (PPO) plan, but requires prior authorization. This plan has a copay of $105 for partial hospitalization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including services not usually covered by Medicare, are covered. Ground and Air Ambulance Services have a $280 copay, and Transportation Services to a plan-approved health-related location have no copay for up to 24 one-way trips per year, with coverage for rideshare services, bus/subway, and medical transport. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $125, $30, and $125 respectively, with no coinsurance. Worldwide Urgent Coverage also has a copay of $125 with no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist Open (PPO) plan covers primary care physician services with no copay. Chiropractic services, physician specialist services, occupational therapy services, physical therapy and speech-language pathology services have a $15 copay. Mental health specialty services, psychiatric services, and podiatry services have a $15-$25 copay depending on the service. Additional telehealth benefits have a $0-$30 copay, and opioid treatment program services have a $15 copay.
Preventive Services See details
The Wellcare Assist Open (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services have a copay, and other services like health education, in-home safety assessments, medical nutrition therapy, and others are not covered. Kidney disease education services have a 20% coinsurance, and other preventive services include glaucoma screening, diabetes self-management training, barium enemas, and others with no copay.
Hearing Services See details
Hearing services include hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per ear annually, with no copay for Prescription Hearing Aids (all types). Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Assist Open (PPO) plan covers vision services, including routine eye exams with a copay of $0 - $15 and eyewear with no copay. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades; a combined maximum of $300 applies to these services.
Dental Services See details
The Wellcare Assist Open (PPO) plan covers Medicare Dental Services with a $15 copay, and other dental services with no copay. Oral exams, dental X-rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with no copay, while Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. Orthodontic Services are covered with a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and 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 Assist Open (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. DME has a 20% coinsurance, while Prosthetic Devices have a 20% coinsurance and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $50, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $280, Therapeutic Radiological Services have a coinsurance of 20% at a minimum, and Outpatient X-Ray Services have a $45 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist Open (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Assist Open (PPO) plan. The plan does not cover any Cardiac Rehabilitation services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Assist Open (PPO) plan, but require prior authorization. There is no copay for days 1-20 and 71-100, but there is a $214 copay for days 21-70; there is no coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Assist Open (PPO) plan's "Other Services" benefit covers over-the-counter (OTC) items with no copay, and a maximum benefit of $140 every three months, including nicotine replacement therapy and naloxone coverage. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and a variety of other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are not covered.
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