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Wellcare Assist Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Assist 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 Assist 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 Assist 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 Assist Open (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.30. 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 $580.00 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 $13300.00 (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 $13300.00 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 Assist Open (PPO) plan has a $580 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. The copays range from $0 to $100, while the coinsurance is either 24% or 25%. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium is $28.30.
Additional Benefits
The Wellcare Assist Open (PPO) plan offers a wide range of benefits, with a focus on outpatient and preventative care. Many services, such as primary care visits, preventive services, vision and dental services, and home health services, have no copay. The plan also covers inpatient hospital stays, outpatient services, and emergency services, with varying copays and coinsurance amounts depending on the service. This plan provides coverage for hearing aids, medical equipment, and diagnostic services. It also includes additional benefits like OTC items and meal benefits, both with no copay. Certain services may require a copay or coinsurance, and some require prior authorization.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $490 for days 1-4 and no copay for days 5-90 for acute care, and a copay of $465 for days 1-4 and no copay for days 5-90 for psychiatric care. Additional days for inpatient hospital-acute have no copay for days 91-100, but non-Medicare covered stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a 20% coinsurance and a copay between $0 and $400, observation services with a 20% coinsurance and a $110 copay, and ambulatory surgical center services with a $250 copay. Outpatient substance abuse services have a $25 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist Open (PPO) plan, but requires prior authorization. You will pay a copay of $80 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Assist Open (PPO) plan. Medicare-covered ground and air ambulance services each have a $325 copay, and there is no coinsurance. 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 Assist Open (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay and no coinsurance, while Urgently Needed Services have a $35 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist Open (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, but routine care is not covered. Occupational Therapy has a $25 copay. Physician Specialist Services have a $25 copay, while mental health specialty services, individual and group psychiatric sessions, and opioid treatment program services have a minimum copay of $25 and a maximum copay of $25. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay between $0 and $35.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services with a copay. Kidney Disease Education Services have a 20% coinsurance, while Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Other services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $350 per ear per year, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $25, and eyewear with a $0 copay. Routine eye exams are limited to one per year with no copay. Eyewear has a combined maximum benefit of $100 per year for both in-network and out-of-network services, and includes contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, all with no copay.
Dental Services See details
The Wellcare Assist Open (PPO) plan covers Medicare Dental Services with a $25 copay, and covers other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay. This plan also covers orthodontic services up to $1,000 per year. Prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Assist Open (PPO) plan, but require prior authorization. Medicare Part B Insulin Drugs have 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 Assist Open (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), prosthetics, medical supplies, and diabetic equipment, is covered. DME and Prosthetic Devices have a 20% coinsurance, while Medical Supplies also have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance and some services have a copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $30, and lab services with no copay. Radiological services are also covered, with diagnostic radiological services having a copay of at most $400, therapeutic radiological services having a coinsurance of at least 20%, and outpatient X-ray services having a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist 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 covered by the Wellcare Assist Open (PPO) plan, but the plan does not cover any of the sub-services. There is a copay for some services, but the specific copay information is not available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Assist Open (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, while days 21-60 have a $214 copay; there is no coinsurance.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits, both with no copay, and a maximum OTC benefit of $85 every three months. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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