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Wellcare Dual Access Open (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access Open (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Dual Access Open (PPO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access Open (PPO D-SNP) is a PPO D-SNP 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 Dual Access Open (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Dual Access Open (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Dual Access Open (PPO D-SNP).
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 Dual Access Open (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.80. 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 $470.00 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 $13900.00 (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 $13900.00 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 Dual Access Open (PPO D-SNP) prescription drug plan features an annual drug deductible of $470. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply at preferred pharmacies, with no copay required for a three-month supply ordered through preferred mail order. Additionally, Tier 6 select care drugs are highly accessible, offering no copay across all participating pharmacy and mail order options. For higher-tier prescription medications, costs are determined by coinsurance during the initial coverage phase. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 32% coinsurance for all supply durations. Tier 5 specialty drugs are covered with a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers comprehensive medical coverage with varying cost-sharing requirements. Inpatient hospital admissions require a $2,050 copay with no coinsurance, while outpatient services, primary care, specialists, and diagnostics generally feature no copay and a 20% coinsurance. Emergency room visits carry a $115 copay and urgent care has a $40 copay, both of which are waived if you are admitted to the hospital within 24 hours. For supplemental care, this plan provides robust dental, vision, and hearing benefits with no deductibles. Preventive and comprehensive dental services are covered up to a $3,000 annual maximum with no copay and no coinsurance, while prescription hearing aids are covered up to $1,000 per ear with no copay or coinsurance. Additionally, members benefit from no copay and no coinsurance for home health services, over-the-counter items, and chronic illness meals.
Inpatient Hospital See details
Wellcare Dual Access Open (PPO D-SNP) inpatient hospital benefits are partially covered, featuring a $2,050 copay per admission and no coinsurance for Medicare-covered acute and psychiatric stays. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access Open (PPO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copays and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Wellcare Dual Access Open (PPO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Dual Access Open (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 annual one-way trips to plan-approved locations, though transportation to any other health-related locations is not covered.
Emergency Services See details
Wellcare Dual Access Open (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum benefit with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access Open (PPO D-SNP) covers primary care, specialist, therapy, and psychiatric services with no copay and a 20% coinsurance, though routine chiropractic care is not covered. Podiatry services are covered with no copay and no coinsurance for up to six routine visits per year, while telehealth options are available with a $0 to $40 copay and a 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Wellcare Dual Access Open (PPO D-SNP), offering annual physical exams, alternative therapies, memory fitness, and remote access technologies with no copay and no coinsurance. Kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs are covered with no copay and a 20% coinsurance. Uncovered services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Dual Access Open (PPO D-SNP) covers hearing services with no deductible, offering one routine hearing exam per year with a 20% coinsurance and no copay, and one fitting evaluation with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear annually, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Dual Access Open (PPO D-SNP) covers vision services with no deductible, offering one routine eye exam per year with no copay and a 20% coinsurance, though other eye exam services are not covered. Covered eyewear has a combined annual limit of $300 with no copay, requiring a 20% coinsurance for contact lenses and no coinsurance for eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Wellcare Dual Access Open (PPO D-SNP) offers partially covered dental services, which feature no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered preventive and comprehensive services up to a $3,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access Open (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Dual Access Open (PPO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access Open (PPO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access Open (PPO D-SNP) covers diagnostic and radiological services, including lab tests, therapeutic radiology, and outpatient X-rays, with no copay and a minimum 20% coinsurance. Prior authorization is required for all of these covered diagnostic and radiological services.
Home Health Services See details
Wellcare Dual Access Open (PPO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Access Open (PPO D-SNP) offers Cardiac Rehabilitation Services with no copay, though only some services are covered in practice. Cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan and are subject to a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access Open (PPO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond the 100-day Medicare limit are not covered. There is no copay for days 1 to 20 and days 71 to 100, while days 21 to 70 require a $218 daily copay.
Other Services See details
Wellcare Dual Access Open (PPO D-SNP) provides partial coverage for other services, featuring over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, highly integrated SNP services, and other miscellaneous services are not covered under this benefit, and a referral is required to receive meals.
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