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Wellcare Simple Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Simple Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in MI. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Simple 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 Simple 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 Simple 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.
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 $420.00 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 $7500.00 (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 $7500.00 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 Simple Open (PPO)
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Drug Coverage
The Wellcare Simple Open (PPO) plan has a $420 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For the initial coverage phase, you will pay no copay for preferred generic drugs and specialty tier drugs at preferred pharmacies. Standard generic drugs have a 25% coinsurance, and preferred brand drugs have a 45% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers comprehensive coverage with varying costs. For inpatient hospital stays, you'll pay a copay of $350 for the first 7 days, with no copay thereafter. Outpatient services have copays ranging from $0 to $280, while primary care visits, preventive services, and many vision and dental services have no copays. The plan includes coverage for ambulance services, with a $250 copay, and emergency services with a $125 copay. It also covers hearing exams, prescription hearing aids, and offers benefits like OTC items and meal benefits. Diagnostic and radiological services have a copay that can range from $0 to $280, and skilled nursing facilities have a copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a \$350 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you pay a \$300 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $280, observation services have a copay between $125 and $280, and ambulatory surgical center services have a $200 copay. Outpatient substance abuse services, including individual and group sessions, have a $40 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple Open (PPO) plan, with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple Open (PPO) plan, with prior authorization required. Ground and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location have no copay and cover up to 12 one-way trips per year via rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered under the Wellcare Simple Open (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a copay of $125, and Worldwide Urgent Coverage has a copay of $125. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $30 copay, and mental health specialty services with a $40 copay for individual and group sessions. The plan also covers other health care professional services with a copay between $0 and $30, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services like Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit, all with no copay. Kidney disease education services have a 20% coinsurance. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Fitness benefits and remote access technologies have no copay. Alternative therapies have no copay.
Hearing Services See details
Wellcare Simple Open (PPO) covers hearing exams with a $30 copay, and covers routine hearing exams and fitting/evaluation for hearing aids with no copay, each limited to once per year. Prescription hearing aids are covered, with a maximum benefit of $500 per year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$30, routine eye exams with no copay, and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum plan benefit coverage of $200 per year.
Dental Services See details
The Wellcare Simple Open (PPO) plan covers dental services, including Medicare Dental Services with a $30 copay, and other dental services such as oral exams, dental x-rays, and cleanings with no copay. Orthodontic services are covered up to a maximum of $3,000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Simple Open (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, 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 by the Wellcare Simple Open (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Wellcare Simple Open (PPO) covers medical equipment including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment (DME) has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a minimum copay of $0 for diagnostic procedures and tests, and a copay of $74 for outpatient X-ray services, up to a maximum copay of $280 for diagnostic radiological services. Therapeutic radiological services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple 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
Wellcare Simple Open (PPO) covers Cardiac Rehabilitation Services, but none of the sub-services are covered. The plan does not specify a copay or coinsurance for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Open (PPO) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Simple Open (PPO) plan's "Other Services" benefit covers over-the-counter (OTC) items and meal benefits. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered. OTC items have no copay and a maximum benefit coverage amount of $77.00 every three months. Meal benefits have no copay and require a doctor's referral.
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