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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 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 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 $101.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $270.00 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 $12450.00 (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 $12450.00 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) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail order service. Additionally, Tier 6 select care drugs feature no copay across all network pharmacy and mail order options. Standard pharmacies charge copays ranging from $5 to $30 for Tier 1 and Tier 2 generic drugs depending on the supply duration. For higher-tier medications, you will pay 25% coinsurance for Tier 3 preferred brands and Tier 5 specialty drugs, and 50% coinsurance for Tier 4 non-preferred drugs.
Additional Benefits
The Wellcare Giveback Open (PPO) plan offers coverage for everyday healthcare needs, featuring no copay and no coinsurance for primary care visits, annual physicals, and routine preventive services. For specialized medical care, members pay a $45 copay for specialist visits and a $35 copay for physical and occupational therapy. If hospital care is required, outpatient services range from no copay to a $450 copay, while inpatient acute hospital stays require a $325 daily copay for the first eight days and no copay for days nine through ninety. This plan also includes valuable supplemental benefits, such as no copay for preventive dental cleanings, routine hearing exams, and annual routine eye exams. Additionally, members receive a $200 yearly eyewear allowance with no copay and up to $500 per ear for prescription hearing aids. Other essential services like home health care and diagnostic lab tests are available with no copay, while durable medical equipment requires a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Giveback Open (PPO) with no coinsurance, though prior authorization is required. For acute care, there is a $325 daily copay for days 1 to 8 and no copay for days 9 to 90, while psychiatric stays require a $1,850 copay per stay; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Giveback Open (PPO) outpatient services are covered with no coinsurance, featuring outpatient hospital copays ranging from no copay to $450 and ambulatory surgical center copays of $300. Outpatient substance abuse services require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Wellcare Giveback Open (PPO) covers partial hospitalization with a $105.00 copay and no coinsurance. Prior authorization is required for this service.
Ambulance and Transportation Services See details
Wellcare Giveback Open (PPO) partially covers ambulance and transportation services, requiring a $350 copay and no coinsurance for ground and air ambulance services, which require prior authorization. Transportation services 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 urgently needed care with a $40 copay, both with no coinsurance and subject to the plan deductible unless waived by hospital admission 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) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Physical and occupational therapy require a $35 copay, mental health services require a $40 copay, and telehealth ranges from no copay to a $45 copay, all with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Giveback Open (PPO) covers annual physical exams and Medicare-covered preventive services with no copay and no coinsurance, while kidney disease education is offered with no copay and a 20% coinsurance. Additional preventive benefits are partially covered with no copay or coinsurance for fitness programs, alternative therapies, and remote access, though services like health education, personal emergency response systems, and nutritional/dietary benefits are not covered.
Hearing Services See details
Wellcare Giveback Open (PPO) covers hearing services with a $45 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual limit per ear, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Giveback Open (PPO) with no coinsurance, offering eye exams with a $0 to $45 copay—including one routine annual exam at no copay—and up to a $200 yearly allowance for eyewear with no copay, though other eye exam services are not covered.
Dental Services See details
Dental services are covered by Wellcare Giveback Open (PPO), which features a $45 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive care like cleanings and exams. The benefit is partially covered, meaning restorative services, endodontics, periodontics, 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, though prior authorization and step therapy may be required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a coinsurance of 0% to 20%.
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 (DME), prosthetics, medical supplies, and diabetic equipment, subject to prior authorization. Covered DME, prosthetics, and medical supplies require no copay and a 20% coinsurance, while diabetic supplies have 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, and diagnostic tests with a copay of $0 to $75. Outpatient X-rays require a $50 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
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) features no coinsurance for Cardiac Rehabilitation Services and some services are covered, though standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Giveback Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and 61 to 100, and a $218 copay for days 21 to 60. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Wellcare Giveback Open (PPO) plan, meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, and meal benefits.
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