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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 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 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 $410.00 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) plan has a $410 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. For specialty tier drugs, you will pay no copay. The plan also offers coinsurance for other drug tiers.
Additional Benefits
The Wellcare Giveback Open (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. You will have no copay for primary care visits, preventive services, vision and dental services, and home health services. The plan also covers hearing exams, prescription hearing aids, and home infusion bundled services. This plan includes coverage for emergency services, ambulance services, and diagnostic services, with associated copays and coinsurance. Additionally, you will have a copay for partial hospitalization, skilled nursing facilities, and some therapies. However, it's important to note that this plan does not cover certain services, such as cardiac rehabilitation and additional hours of care.
Inpatient Hospital See details
Inpatient Hospital coverage under the Wellcare Giveback Open (PPO) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-8, and no copay for days 9-90; however, additional days, non-Medicare covered stays, and upgrades are not covered. Inpatient Hospital Psychiatric services have a $1850 copay for Medicare-covered stays, and additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $450, observation services with a copay between $110 and $450, and ambulatory surgical center services with a $300 copay. Outpatient substance abuse services have a copay of $40 for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Giveback Open (PPO) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $300 copay; however, transportation services to any health-related location are not covered. Prior authorization is required for all ambulance services.
Emergency Services See details
Emergency Services are covered under the Wellcare Giveback Open (PPO) plan with a $110 copay and no coinsurance. Urgently Needed Services have a $40 copay and no coinsurance, and Worldwide Emergency Services have a $110 copay and no coinsurance for Worldwide Emergency Coverage and Worldwide Urgent Coverage, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Giveback Open (PPO) plan covers primary care physician services with no copay and chiropractic services with a $15 copay, but routine chiropractic care is not covered. The plan also covers occupational therapy services with a $35 copay, physician specialist services with a $45 copay, mental health specialty services with a $40 copay, and physical therapy and speech-language pathology services with a $35 copay. Additionally, it covers other health care professional services with a copay between $0 and $45, psychiatric services with a $40 copay, and additional telehealth benefits with a copay between $0 and $45.
Preventive Services See details
Preventive Services, including Medicare-covered services, are covered. Annual physical exams are covered with no copay, and additional preventive services are covered with a $0 copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Kidney disease education services have a 20% coinsurance. Some services, such as health education, in-home safety assessments, and others, are not covered.
Hearing Services See details
The Wellcare Giveback Open (PPO) plan covers hearing exams with a $45 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 year, but prescription hearing aids for inner ear, outer ear, and over the ear are not covered, 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 of $0-$45, and eyewear with no copay and a combined maximum benefit of $200 per year. 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 and other dental services, including oral exams, dental x-rays, other diagnostic and preventive services, with no copay for some services, and a $45 copay for Medicare dental services. However, restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, and oral surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Giveback Open (PPO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, 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, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment are covered. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. 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, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered, with a copay of up to $75 for diagnostic procedures/tests and no copay for lab services. Radiological services are covered with a copay of up to $350 for diagnostic services, 20% coinsurance for therapeutic services, and a $100 copay for outpatient X-rays.
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 not covered by the Wellcare Giveback Open (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Giveback Open (PPO) plan, but require prior authorization. For days 1-20 and 71-100, there is no copay, but for days 21-70, the copay is $214.
Other Services See details
Other Services are not covered under the Wellcare Giveback Open (PPO) plan. Specifically, acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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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