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Wellcare Patriot Giveback Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Patriot 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 Patriot Giveback Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Patriot 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 Patriot Giveback Open (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Patriot 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 Patriot 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 $150.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13300.00 (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 $13300.00 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
Prescription drugs are not covered by Wellcare Patriot Giveback Open (PPO).
Additional Benefits
The Wellcare Patriot Giveback Open (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with varying copays, and no copays for outpatient substance abuse and blood services. The plan also includes coverage for ambulance services, emergency services, primary care, preventive services, and vision and dental services, with specific copays and coinsurance amounts detailed for each. The plan also covers home health services, skilled nursing, and medical equipment. This plan provides additional benefits, such as hearing services, though prescription hearing aids and OTC hearing aids are not covered. You will also find coverage for dialysis services, diagnostic and radiological services, and cardiac rehabilitation. However, some services like transportation to health-related locations, additional hours of care, and several "other services" are not covered.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered under the Wellcare Patriot Giveback Open (PPO) plan. For acute care, you will pay a $325 copay for days 1-8, and no copay for days 9-90; for psychiatric care, you will pay a $325 copay for days 1-6, and no copay for days 7-90. Additional days for inpatient hospital-acute and psychiatric, and non-Medicare-covered stays for both, are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $350, observation services with a copay between $110 and $350, and ambulatory surgical center services with a $250 copay. Outpatient substance abuse services, including individual and group sessions, have no copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Patriot Giveback Open (PPO) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Patriot Giveback Open (PPO) plan. Ground and Air Ambulance Services have a $280 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services under the Wellcare Patriot Giveback Open (PPO) plan includes a $110 copay, while Urgently Needed Services have a $30 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $110 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Patriot Giveback Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services, physical therapy, and speech-language pathology services with a $35 copay. Mental health and psychiatric individual and group sessions have no copay, and other health care professional services have a copay between $0 and $35. Additional telehealth benefits have a copay between $0 and $35, and opioid treatment program services have a $35 copay.
Preventive Services See details
The Wellcare Patriot Giveback Open (PPO) plan covers preventive services, including an annual physical exam with no copay. Other services, such as Health Education, In-Home Safety Assessment, and Personal Emergency Response System (PERS), are not covered.
Hearing Services See details
Hearing Services are partially covered by the Wellcare Patriot Giveback Open (PPO) plan. Hearing exams have a $35 copay, but routine hearing exams and fitting/evaluation for hearing aids are not covered, and prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Patriot Giveback Open (PPO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $35, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $200 per year.
Dental Services See details
The Wellcare Patriot Giveback Open (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic, preventive, restorative, and oral surgery services, all with no copay. Orthodontic services are covered up to a maximum of $2000 per year. Prosthodontics, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Patriot Giveback Open (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Patriot Giveback Open (PPO) plan, with a 20% coinsurance for Durable Medical Equipment and Prosthetic Devices. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay for Medicare-covered diagnostic procedures, tests, and lab services that ranges from $0 to $100, and a copay of up to $250 for diagnostic radiological services. Therapeutic radiological services have a 20% coinsurance, and outpatient X-ray services have a $100 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Patriot 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 covered, but 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 are not covered. The plan has a copay for Cardiac Rehabilitation Services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a $0 copay for days 1-20, a $214 copay for days 21-70, and a $0 copay for days 71-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Patriot Giveback Open (PPO) plan's "Other Services" benefit does not cover acupuncture, over-the-counter items, meal benefits, 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. No authorization or referrals are required for these services.
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