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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 2026, 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 2026.
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 $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 $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:
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Drug Coverage
The Wellcare Simple Open (PPO) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy, Tier 1 copays range from $5 to $15, while Tier 2 copays range from $10 to $30 depending on the supply fill. Higher-tier medications are subject to coinsurance rather than flat copays, with Tier 3 preferred brands and Tier 5 specialty drugs requiring a 25% coinsurance. Tier 4 non-preferred drugs carry a 34% coinsurance at preferred pharmacies and a 36% coinsurance at standard pharmacies. Utilizing preferred network pharmacies and mail-order options is the most cost-effective way to manage your prescription costs under this plan.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers comprehensive coverage with predictable out-of-pocket costs, including no copay for primary care visits, routine annual physicals, and home health services. For specialist visits and urgent care, members pay low copays of $35 and $45 respectively, while inpatient hospital stays require a $375 daily copay for the first seven days and no copay thereafter. Outpatient hospital services and emergency room visits are covered with no coinsurance, featuring copays up to $280. Supplemental benefits are a key highlight, offering no copay for routine dental, vision, and hearing exams, with generous coverage limits of up to $3,000 for dental care and $200 for annual eyewear. Members also pay no copay for over-the-counter items and diagnostic lab work, while durable medical equipment and dialysis require a standard 20% coinsurance. Additionally, skilled nursing facility stays feature no copay for days 1 through 20 and days 51 through 100.
Inpatient Hospital See details
Wellcare Simple Open (PPO) partially covers inpatient hospital care with no coinsurance, though prior authorization is required. For Medicare-covered acute stays, you will pay a $375 copay for days 1 to 7 and no copay for days 8 to 90, while psychiatric stays require a $300 copay for days 1 to 7 and no copay for days 8 to 90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple Open (PPO) covers outpatient services with no coinsurance, featuring a $0 to $280 copay for outpatient hospital services, a $130 to $280 copay per stay for observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay with no coinsurance, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Simple Open (PPO) with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple Open (PPO) covers ground and air ambulance services with a $250 copay and no coinsurance. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Simple Open (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $45 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple Open (PPO) offers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, occupational therapy, and opioid treatment services require a $35 copay and no coinsurance. Mental health and psychiatric sessions have a $40 copay and no coinsurance, telehealth ranges from no copay to a $45 copay with no coinsurance, podiatry is not covered, and though some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Wellcare Simple Open (PPO) provides preventive services, including annual physical exams and screenings, with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Additional supplemental benefits are partially covered, offering alternative therapies, memory fitness, and remote access with no copay and no coinsurance, whereas health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by the Wellcare Simple Open (PPO), featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Wellcare Simple Open (PPO) offers partially covered vision services with no deductibles and no coinsurance, though prior authorization is required. Routine eye exams and eyewear are available with no copay, up to a $200 annual combined limit for eyewear, but other eye exam services are not covered.
Dental Services See details
Wellcare Simple Open (PPO) offers partially covered dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for most preventive and comprehensive services up to a $3,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple Open (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Simple Open (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment benefits under Wellcare Simple Open (PPO) cover durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with most services requiring prior authorization. Covered DME, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts have no copay and a 20% coinsurance, while diabetic supplies from specified manufacturers are available with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Wellcare Simple Open (PPO) with prior authorization required. Diagnostic lab services and diagnostic radiological services have no copay and no coinsurance, while diagnostic tests and procedures carry a $0 to $100 copay and no coinsurance. Outpatient X-rays require a $50 copay, and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Wellcare Simple Open (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under Wellcare Simple Open (PPO), though in practice some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copays of $40, $50, $35, and $25 respectively.
Skilled Nursing Facility (SNF) See details
Wellcare Simple Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 51 through 100, a $218 daily copay for days 21 through 50, and additional days beyond the standard 100-day Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple Open (PPO) provides partial coverage for other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this benefit, and the meal benefit requires a referral.
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