A non-government entity
Wellcare Low Premium Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Low Premium Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Low Premium Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Low Premium 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 Low Premium 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 Low Premium 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 Low Premium Open (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.00. 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 Low Premium Open (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Low Premium Open (PPO) plan has a $420 deductible for prescription drugs. Once you meet your deductible, your cost will vary depending on the drug tier and pharmacy you use. For generic drugs, you may pay no copay or a $10 copay, and for brand name drugs, you will pay coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Low Premium Open (PPO) plan offers a range of benefits. Inpatient hospital stays have a copay, while outpatient services include copays for various services like hospital visits and substance abuse treatment. The plan also covers ambulance services, emergency services, and primary care, with varying copays for different services. Additional benefits include coverage for preventive, hearing, vision, and dental services, often with no copay or low copays. Home infusion, dialysis, medical equipment, and diagnostic services are also included, with some services requiring coinsurance. The plan provides additional benefits like a meal allowance and over-the-counter items, with no copay.
Inpatient Hospital See details
Inpatient Hospital-Acute services have a copay of $350 for days 1-7, and no copay for days 8-90, while Inpatient Hospital Psychiatric services have a copay of $300 for days 1-7, and no copay for days 8-90. Additional days, non-Medicare-covered stays, and upgrades for inpatient hospital-acute and additional days, and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
The Wellcare Low Premium Open (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $280, and observation services with a copay between $125 and $280. Ambulatory Surgical Center (ASC) services have a $200 copay, and outpatient substance abuse services have a $40 copay for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Low Premium Open (PPO) plan, but requires prior authorization. You will pay a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Low Premium Open (PPO) plan. Ground and air ambulance services have a $275 copay, and transportation services to a plan-approved health-related location have no copay for up to 12 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, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare Low Premium Open (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services have a $45 copay, and all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Low Premium Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, and physician specialist services with a $30 copay. Mental health specialty services, including individual and group sessions, have a $40 copay. Other benefits include physical therapy and speech-language pathology services with a $30 copay, and additional telehealth benefits with a copay between $0 and $45.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero-dollar preventive services, annual physical exams with no copay, and additional preventive services with a copay for fitness, remote access technologies, and alternative therapies. Kidney Disease Education Services have a 20% coinsurance, and other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, have no copay.
Hearing Services See details
Wellcare Low Premium Open (PPO) covers hearing exams for a $30 copay and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $1000 per ear annually, while OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision Services are covered by the Wellcare Low Premium Open (PPO) plan, including eye exams with a copay between $0 and $30, and eyewear with no copay. Eyewear has a combined maximum benefit of $500 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services include Medicare dental services with a $30 copay, oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Orthodontic services are covered up to a $4000 maximum, 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 Low Premium Open (PPO) plan. This includes Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Low Premium Open (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Wellcare Low Premium Open (PPO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered by the Wellcare Low Premium Open (PPO) plan. Diagnostic procedures/tests have a copay between $0 and $100, while lab services have no copay. Diagnostic radiological services have a copay up to $280. Therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Low Premium Open (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Low Premium Open (PPO) plan, but the specific services are not covered. The plan has a copay, but the amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Low Premium Open (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the Wellcare Low Premium Open (PPO) plan, acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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 items are covered with no copay, and a meal benefit is covered with no copay.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved