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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 2025, 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 2025.
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 $23.00. 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 $260.00 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 $14000.00 (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 $14000.00 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) plan has a $260 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you'll pay a $19-$20 copay for preferred generic drugs, 22% coinsurance for standard generic drugs, and a $100 copay for preferred brand drugs. Specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for covered drugs.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan provides a range of benefits with varying costs. Inpatient hospital stays have a $1860 copay per admission, while outpatient services, partial hospitalization, and ambulance services have a 20% coinsurance. Emergency services have a $110 copay, and primary care, hearing, vision, and dental services have a mix of no copays and 20% coinsurance, with specific coverage limits for eyewear and orthodontic services. Preventive services include no copays for many services, and additional benefits like hearing aids (up to $2,000 per ear per year) and home health services are available. The plan also offers additional coverage for medical equipment, dialysis, and diagnostic services, with no copays for home health and lab services. The plan does not cover certain services, such as Cardiac Rehabilitation Services and certain "Other Services", but it does provide OTC benefits up to $100 per month and a meal benefit when referred by a doctor.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Wellcare Dual Access Open (PPO D-SNP) plan, with a copay of $1860 per admission or stay. Additional days and non-Medicare-covered stays for inpatient hospital acute and psychiatric care, along with upgrades, are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a 20% coinsurance and no copay, observation services with a 20% coinsurance, ambulatory surgical center services with a 20% coinsurance, outpatient substance abuse services with a 20% coinsurance, and outpatient blood services with a 20% coinsurance. The plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Access Open (PPO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay and are limited to 24 one-way trips per year using rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Wellcare Dual Access Open (PPO D-SNP) plan with a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay and no coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
Under the Wellcare Dual Access Open (PPO D-SNP) plan, primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. You will pay 20% coinsurance for primary care physician services, chiropractic services, physician specialist services, occupational therapy, physical therapy, and speech-language pathology services, additional telehealth benefits, opioid treatment program services, individual and group sessions for mental health specialty services, and individual and group sessions for psychiatric services. Podiatry services have no copay, and the coinsurance is 20% for routine foot care. Additional telehealth benefits have a copay between $0 and $45, and 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams with no copay, and additional preventive services, with copays for Fitness Benefit, Remote Access Technologies, Personal Emergency Response System (PERS), Alternative Therapies, and In-Home Support Services. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay, with a 20% coinsurance for routine hearing exams, limited to one visit per year. Prescription hearing aids are covered up to $2,000 per ear per year, with no copay, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum plan benefit coverage amount of $500 per year.
Dental Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers Medicare dental services with 20% coinsurance, and other dental services, including oral exams, dental x-rays, other diagnostic services, prophylaxis, fluoride treatments, and other preventive services, with no copay. This plan has a $4,000 maximum benefit for orthodontic services per year, and other services such as restorative services, endodontics, periodontics, prosthodontics, and oral surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Wellcare Dual Access Open (PPO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and requires prior authorization. Prosthetics/Medical Supplies and Diabetic Equipment are covered, with coinsurance of 20% for certain services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Radiological Services have a coinsurance of at most 20%. Lab services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access Open (PPO D-SNP) 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 under the Wellcare Dual Access Open (PPO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan with prior authorization required. You will have no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered SNF stays and non-Medicare-covered stays are not covered.
Other Services See details
Under "Other Services", acupuncture, 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. Over-the-counter (OTC) items are covered with no copay and a maximum benefit coverage amount of $100.00 per month, and a meal benefit is covered with no copay when referred by a doctor.
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