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Wellcare Premium Ultra Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Premium Ultra Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Premium Ultra Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Premium Ultra Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in NY. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Wellcare Premium Ultra 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 Premium Ultra 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 Premium Ultra Open (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $114.00. 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 $3400.00 (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 $3400.00 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 Premium Ultra Open (PPO)
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Drug Coverage
The Wellcare Premium Ultra Open (PPO) plan has an enhanced alternative drug benefit. The plan has a $420 deductible. After the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and standard mail order, but have a $10 copay at standard pharmacies. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Premium Ultra Open (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays depending on the service. You'll find no copays for primary care visits, routine hearing exams, vision services, and many dental services. This plan also covers emergency services, ambulance services, and home health services, each with specific copays or coinsurance. Additional benefits include coverage for hearing aids, prescription drugs, and medical equipment, with some services requiring prior authorization.
Inpatient Hospital See details
Inpatient Hospital services include acute and psychiatric care, with a copay of $425 for days 1-3 and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-120, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $450, observation services with a copay between $140 and $450, ambulatory surgical center services with a $150 copay, and outpatient substance abuse services with a $10 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Premium Ultra Open (PPO) plan, but requires prior authorization. You will have a $130 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Premium Ultra Open (PPO) plan. Ground and air ambulance services have a $350 copay, with no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Premium Ultra Open (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services has a $35 copay, and all three services have no coinsurance. Worldwide Urgent Coverage has a $140 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Premium Ultra Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $10 copay, occupational therapy services with a $10 copay, and specialist, mental health, and psychiatric services with a $10 copay. Physical therapy and speech-language pathology services have a $10 copay, and additional telehealth benefits have a copay between $0 and $35. Opioid treatment program services have a $10 copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services, some of which have a copay. The plan also covers kidney disease education services with 20% coinsurance.
Hearing Services See details
The Wellcare Premium Ultra Open (PPO) plan covers hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $750 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Wellcare Premium Ultra Open (PPO) plan covers vision services, including eye exams with a copay of $0-$10, and eyewear with a combined maximum benefit of $200 per year with no copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are all covered with no copay.
Dental Services See details
The Wellcare Premium Ultra Open (PPO) plan covers Medicare Dental Services with a $10 copay, and 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), Prosthodontics (fixed), and Oral and Maxillofacial Surgery with no copay. Orthodontic Services are covered up to a maximum of $1000 per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Premium Ultra Open (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a 20% coinsurance, and durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a 20% coinsurance. Diabetic supplies have no copay, and 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 no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $375, Therapeutic Radiological Services with coinsurance of at least 20%, and Outpatient X-Ray Services with a $25 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Wellcare Premium Ultra Open (PPO) 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 by the Wellcare Premium Ultra Open (PPO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Premium Ultra Open (PPO) plan, but require prior authorization. You will have no copay for days 1-20 and days 51-100, but a $214 copay for days 21-50. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items and Meal Benefit with no copay, while 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. OTC items have a maximum benefit coverage amount of $50 every three months.
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