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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 2026, 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 ME. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $35.00. 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 $615.00 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:
Sign up for Wellcare Low Premium Open (PPO)
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Drug Coverage
The Wellcare Low Premium Open (PPO) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generics and Tier 2 generics when filled at a preferred pharmacy or through preferred mail order. Tier 6 select care drugs also feature no copay across all standard and preferred pharmacies, while standard pharmacy copays for Tier 1 and Tier 2 drugs range from $5 to $30 depending on the supply. For higher-tier medications, the plan transitions to a percentage-based coinsurance during the initial coverage phase. You will pay a 25% coinsurance for Tier 3 preferred brands and Tier 5 specialty drugs, while Tier 4 non-preferred drugs require a 36% coinsurance. These coinsurance rates apply consistently across both preferred and standard pharmacies as well as mail-order services.
Additional Benefits
The Wellcare Low Premium Open (PPO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care visits, home health services, and preventive care like annual physicals. For more specialized care, members pay a $35 copay with no coinsurance for specialist visits, while emergency room visits require a $115 copay. Inpatient hospital stays feature no coinsurance but do require a copay of $600 per day for the first four days, followed by no copay for days 5 through 100. This plan also includes valuable dental, vision, and hearing benefits to help lower your out-of-pocket costs. Routine hearing and vision exams feature no copay, and the plan provides annual allowances of up to $1,000 for dental care, $500 per ear for hearing aids, and $100 for eyewear. Additionally, diabetic supplies are covered with no copay, while durable medical equipment requires a 20% coinsurance.
Inpatient Hospital See details
Wellcare Low Premium Open (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $600 copay for days 1 to 4 and no copay for days 5 to 100, while upgrades and non-Medicare-covered stays are not covered. Psychiatric stays incur a $500 copay for days 1 to 4 and no copay for days 5 to 90, but additional psychiatric days and non-Medicare-covered stays are excluded.
Outpatient Services See details
Outpatient services covered by Wellcare Low Premium Open (PPO) include outpatient hospital care with no copay and 30% coinsurance, and observation services for a $115 copay per stay and 30% coinsurance. Ambulatory surgical center services require a $250 copay and no coinsurance, outpatient substance abuse sessions cost a $35 copay and no coinsurance, and blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by the Wellcare Low Premium Open (PPO) plan with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Wellcare Low Premium Open (PPO) covers Medicare-approved ground and air ambulance services with a $300.00 copay and no coinsurance, requiring prior authorization. For transportation, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Wellcare Low Premium Open (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $35 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Low Premium Open (PPO) offers primary care physician services with no copay and no coinsurance, and telehealth benefits with no copay to a $35 copay and no coinsurance. Specialist visits, therapy, and mental health services are covered with a $35 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Wellcare Low Premium Open (PPO), offering no copay and no coinsurance for annual physicals, select screenings, fitness, and remote access, while kidney disease education has no copay and 20% coinsurance. The benefit is partially covered because health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling are not covered.
Hearing Services See details
Wellcare Low Premium Open (PPO) covers Medicare-covered hearing exams for a $35 copay and no coinsurance, while routine hearing exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Low Premium Open (PPO) offers partially covered vision services with no copays or coinsurance, though other eye exam services are not covered. The plan covers one routine eye exam per year and provides up to $100 annually for eyewear, including contacts and eyeglasses, with prior authorization required.
Dental Services See details
Dental services are partially covered by Wellcare Low Premium Open (PPO), with Medicare-covered services requiring a $35 copay and no coinsurance, and other covered preventive and comprehensive services having no copay and no coinsurance up to a $1,000 annual limit. Prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Low Premium Open (PPO) covers Home Infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs are subject to a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Wellcare Low Premium Open (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Low Premium Open (PPO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, subject to prior authorization. Covered diabetic supplies have no copay, though brand limits apply, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Low Premium Open (PPO) covers diagnostic and radiological services under prior authorization, offering lab services with no copay or coinsurance and diagnostic tests for up to a $20 copay and no coinsurance. Covered radiological services include outpatient X-rays for a $50 copay, therapeutic services with a 20% coinsurance, and diagnostic radiological services with a copay and no coinsurance.
Home Health Services See details
Home health services are covered under the Wellcare Low Premium Open (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Low Premium Open (PPO) with no coinsurance, although only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, requiring copays of $30, $40, $25, and $20 respectively.
Skilled Nursing Facility (SNF) See details
Wellcare Low Premium Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 61 to 100, and a $218 daily copay for days 21 to 60. Prior authorization is required, and while a prior three-day hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Low Premium Open (PPO) partially covers other services, offering a chronic illness meal benefit with no copay and no coinsurance, though a referral is required. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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