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Wellcare Dual Access Open (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access Open (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Dual Access Open (PPO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access Open (PPO D-SNP) is a PPO D-SNP 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 3 out of 5 stars in 2026.
It's important to know that Wellcare Dual Access Open (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Dual Access Open (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Dual Access Open (PPO D-SNP).
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 Dual Access Open (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. 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 $510.00 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:
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Drug Coverage
The Wellcare Dual Access Open (PPO D-SNP) Medicare prescription drug coverage includes a $510 annual deductible. For Tier 1 preferred generics and Tier 2 generics, copayments start as low as $18 and $19 for a one-month supply at preferred pharmacies. Beneficiaries can also benefit from no copay on three-month supplies of Tier 1 and Tier 2 drugs through preferred mail order. Brand-name and specialty medications are subject to coinsurance, with Tier 3 preferred brands at 20%, Tier 4 non-preferred drugs at 32%, and Tier 5 specialty drugs at 25%. Notably, Tier 6 select care drugs are fully covered with no copay for all supply durations at any standard or preferred pharmacy.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers comprehensive medical coverage, generally featuring no copays and a 20% coinsurance for primary care, outpatient hospital services, diagnostic tests, and medical equipment. Inpatient hospital stays require a copay of $2,230 for acute care and $2,080 for psychiatric care, while emergency room visits carry a $115 copay that is waived if you are admitted. Skilled nursing facility care is also available with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 70. For everyday wellness, the plan provides preventive services, annual physicals, fitness benefits, and home health services with no copay and no coinsurance. Dental, vision, and hearing benefits are partially covered, offering routine exams with no copay, though a 20% coinsurance applies to select services alongside annual allowances for hearing aids and eyewear. Additionally, members can access over-the-counter items and chronic illness meals with no copay and no coinsurance, though prior authorizations or referrals are required for many specialized services.
Inpatient Hospital See details
Wellcare Dual Access Open (PPO D-SNP) partially covers inpatient hospital services, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care, with no coinsurance and prior authorization required for both. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under the Wellcare Dual Access Open (PPO D-SNP) plan with no copayments, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Dual Access Open (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Wellcare Dual Access Open (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Although transportation is technically covered, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Wellcare Dual Access Open (PPO D-SNP) covers emergency services with a $115 copay and urgent care with a $40 copay, both featuring no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services 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
Primary care and specialist services under the Wellcare Dual Access Open (PPO D-SNP) are generally covered with no copay and a 20% coinsurance, though prior authorization is required for most specialty care. Telehealth benefits have a copay ranging from $0 to $40 with 20% coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Dual Access Open (PPO D-SNP) covers annual physical exams, fitness benefits, and alternative therapies with no copay and no coinsurance, while kidney disease education and select screenings are covered with no copay and a 20% coinsurance. Additional preventive services are only partially covered, with excluded services including health education, in-home safety assessments, personal emergency response systems, and nutritional/dietary benefits.
Hearing Services See details
Hearing services offered by Wellcare Dual Access Open (PPO D-SNP) are partially covered, featuring one annual routine hearing exam with no copay and 20% coinsurance, and one fitting evaluation per year with no copay or coinsurance. Prescription hearing aids are covered up to $750 annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Wellcare Dual Access Open (PPO D-SNP), which excludes other eye exam services. Covered benefits feature no deductibles and no copays, though a 20% coinsurance applies to routine eye exams (limited to one per year) and contact lenses, with a combined eyewear maximum benefit of $100 annually.
Dental Services See details
Wellcare Dual Access Open (PPO D-SNP) offers partially covered dental services, as orthodontics is not covered. Medicare-covered dental services require no copay and a 20% coinsurance, while other preventive and comprehensive dental services are available with no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Dual Access Open (PPO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Dual Access Open (PPO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access Open (PPO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access Open (PPO D-SNP) covers diagnostic and radiological services, including lab services, X-rays, and therapeutic radiology, with a minimum 20% coinsurance and no copay. Prior authorization is required for all of these covered diagnostic and radiological services.
Home Health Services See details
Wellcare Dual Access Open (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Access Open (PPO D-SNP) offers Cardiac Rehabilitation Services with no copay, though in practice, some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access Open (PPO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. Prior authorization is required, and while there is no copay for days 1 to 20 and days 71 to 100, a $218 daily copay applies for days 21 to 70.
Other Services See details
Wellcare Dual Access Open (PPO D-SNP) partially covers other services, providing over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, although a referral is required for meals. Acupuncture and other additional services are not covered under this benefit.
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