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Wellcare Giveback Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Giveback Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Statewide in PA. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Giveback 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 Giveback 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 Giveback 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. Additionally, this plan comes with a Part B Premium reduction of $54.70. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $130.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $10000.00 (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 $10000.00 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 Giveback Open (PPO) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you will pay no copay for preferred generic drugs at a preferred pharmacy or through mail order. For standard generic drugs, you will pay 25% coinsurance. For preferred brand drugs, you will pay 30% coinsurance at a preferred pharmacy and 31% coinsurance at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Giveback Open (PPO) plan offers a range of benefits, including inpatient hospital stays with varying copays, outpatient services with copays, and emergency services with a copay. This plan also covers primary care, preventive services, hearing, vision, and dental services, often with no copay or low copays. Additional benefits of this plan include home health services with no copay, skilled nursing facility stays with no copay for some days, and coverage for durable medical equipment with coinsurance. The plan provides coverage for outpatient substance abuse services, mental health specialty services, and prescription hearing aids, with many services having no copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you will pay a copay of $400 for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a copay of $350 for days 1-5, and no copay for days 6-90. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the Wellcare Giveback Open (PPO) plan, including outpatient hospital services with a copay between $0 and $400, observation services with a copay between $110 and $400, and outpatient substance abuse services with no copay for individual and group sessions. Ambulatory Surgical Center (ASC) Services have a $250 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Giveback Open (PPO) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a $280 copay, while 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 by the Wellcare Giveback Open (PPO) plan, with a $110 copay for Emergency Services and Worldwide Emergency Coverage, and a $40 copay for Urgently Needed Services, with no coinsurance. Worldwide Urgent Coverage is covered with a $110 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Giveback Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $45 copay, and mental health specialty services with no copay for individual and group sessions. This plan also covers other health care professional services with a copay between $0 and $45, psychiatric services with no copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, and additional telehealth and opioid treatment program services with a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
The Wellcare Giveback Open (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, including Alternative Therapies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance. Other services, such as Health Education, In-Home Safety Assessment, and others, are not covered.
Hearing Services See details
The Wellcare Giveback Open (PPO) plan covers hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $350 per ear with no copay for all types of prescription hearing aids, while OTC hearing aids are not covered.
Vision Services See details
The Wellcare Giveback Open (PPO) plan covers vision services, including eye exams with a copay of $0-$45, and eyewear with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay. There is a combined maximum benefit of $100 per year for all eyewear.
Dental Services See details
The Wellcare Giveback Open (PPO) plan covers Medicare dental services with a $45 copay, and covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and adjunctive general services with no copay. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Giveback Open (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $75, lab services with no copay, and diagnostic radiological services with a copay up to $400. Therapeutic radiological services have a 20% coinsurance, and outpatient X-rays have a $45 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback 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.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Giveback Open (PPO) plan, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for the covered services; however, the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Wellcare Giveback Open (PPO) plan. For days 1-20 and days 61-100, there is no copay, while days 21-60 have a $214 copay. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services in the Wellcare Giveback Open (PPO) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit of $30 every three months. Acupuncture, Meal Benefit, 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.
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