A non-government entity
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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Giveback Open (PPO) is a PPO plan offered by American Progressive Life & Hlth Ins Company of NY available for the 2026 plan year to people living in Select counties in NY. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $40.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $250.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 Giveback Open (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
The Wellcare Giveback Open (PPO) prescription drug plan features an annual drug deductible of $615. Members enjoy no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 select care drugs are highly accessible with no copay at all standard and preferred pharmacies or mail-order options. For higher-tier medications, costs transition to coinsurance, with Tier 3 preferred brands and Tier 5 specialty drugs requiring a 25% coinsurance. Tier 4 non-preferred drugs incur a 34% coinsurance across all pharmacy and mail-order types. If you choose a standard pharmacy instead of a preferred one, Tier 1 and Tier 2 drugs will require a small copayment starting at $5 and $10 respectively for a one-month supply.
Additional Benefits
The Wellcare Giveback Open (PPO) plan offers affordable access to essential medical services, featuring no copay and no coinsurance for primary care visits, home health services, and annual preventive physicals. Specialist visits, Medicare-covered dental care, and Medicare-covered hearing exams require a $35 copay with no coinsurance. For more intensive care, inpatient hospital stays carry a $2,015 copay per admission, while emergency room visits have a $115 copay that is waived if you are admitted. Routine dental preventive services, annual routine eye exams, and routine hearing tests are covered with no copay and no coinsurance. However, this plan does not cover routine eyewear, hearing aids, or comprehensive dental services such as restorative care and implants. Additionally, skilled nursing facility stays offer no copay for the first 20 days, while durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
Wellcare Giveback Open (PPO) covers inpatient acute and psychiatric hospital stays with a $2,015 copay per admission and no coinsurance, though prior authorization is required. While ten additional days are covered with no copay for acute stays, non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Wellcare Giveback Open (PPO) covers outpatient hospital services with a $0 to $500 copay and 30% coinsurance, and observation services with a $115 copay per stay and 30% coinsurance. Ambulatory surgical center services require a $475 copay with no coinsurance, and outpatient substance abuse sessions carry a $35 copay with no coinsurance. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Giveback Open (PPO) with a $105.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Giveback Open (PPO) covers Medicare-covered ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required and the copay is not waived if you are admitted to the hospital. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Giveback Open (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 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 benefit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback Open (PPO) provides primary care physician services with no copay and no coinsurance, while specialists, physical therapy, occupational therapy, and mental health services require a $35 copay and no coinsurance. Telehealth benefits are covered with a $0 to $40 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Giveback Open (PPO) preventive services are partially covered, offering annual physical exams, fitness benefits, remote access, and alternative therapies with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Non-covered services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Giveback Open (PPO) covers Medicare-covered hearing exams with a $35 copay and no coinsurance, as well as one routine hearing exam and fitting evaluation per year with no copay and no coinsurance. Although some prescription hearing aid services are covered, prescription hearing aids of all types—including inner ear, outer ear, and over the ear—and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Wellcare Giveback Open (PPO) vision services include one routine eye exam per year with no copay and no coinsurance, though prior authorization is required. Other eye exams and all eyewear benefits, including contact lenses and eyeglasses, are not covered under this plan.
Dental Services See details
Wellcare Giveback Open (PPO) partially covers dental services, offering Medicare-covered dental care for a $35 copay and no coinsurance, and preventive services for no copay and no coinsurance. However, restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implants, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Giveback Open (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Giveback Open (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Giveback Open (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with prior authorization required for most items. These benefits feature no copays, but carry a 20% coinsurance for DME, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Wellcare Giveback Open (PPO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $100 copay. Covered radiological services require prior authorization and feature no copay for diagnostic radiology, a $50 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the Wellcare Giveback Open (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Giveback Open (PPO) offers Cardiac Rehabilitation Services with no coinsurance, but only some services are covered in practice because cardiac rehabilitation ($30 copay), intensive cardiac ($40 copay), pulmonary ($25 copay), and SET for PAD ($20 copay) services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Giveback Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1-20 and 71-100, and a $218 daily copay for days 21-70. Prior authorization is required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services are not covered under the Wellcare Giveback Open (PPO) plan, which excludes acupuncture, over-the-counter (OTC) items, and meal benefits from coverage.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
SMID: MULTIPLAN_HCIHNMEDADVRX27_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 or 1-800-MEDICARE 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.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
© 2026 Dog Media Solutions LLC. All rights reserved