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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 2026, 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 3 out of 5 stars in 2026.
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 $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 $530.00 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 Assist Open (PPO) prescription drug plan features an annual drug deductible of $530. Under this plan, Select Care Drugs in Tier 6 are highly accessible with no copay across all pharmacies and mail-order options. For generic medications, Tier 1 Preferred Generics start at an $18 copay and Tier 2 Generics start at a $19 copay for a one-month supply at preferred pharmacies, while both tiers feature no copay for a three-month supply through preferred mail order. For brand-name and specialty medications, Tier 3 Preferred Brands and Tier 5 Specialty Tier drugs both carry a 25% coinsurance rate. Tier 4 Non-Preferred Drugs are subject to a copay, starting at $100 for a one-month supply at both preferred and standard pharmacies. Utilizing preferred pharmacies and preferred mail-order services for multi-month fills generally offers the greatest cost savings under this plan.
Additional Benefits
The Wellcare Assist Open PPO plan provides comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits, routine preventive services, and home health care. Specialist visits, urgent care, and emergency room services are covered with predictable copays, while inpatient hospital stays feature a daily copay for the first few days and no copay for subsequent days. Outpatient hospital services and durable medical equipment generally carry a twenty percent coinsurance, though diabetic supplies are covered with no copay. In addition to core medical care, this plan offers valuable routine benefits including dental, vision, and hearing services. Members benefit from no copay for routine dental cleanings, annual eye exams, and routine hearing tests, alongside allowances for eyewear and prescription hearing aids. Over-the-counter items and home infusion services are also covered with no copay, helping to keep your overall out-of-pocket health expenses low.
Inpatient Hospital See details
Wellcare Assist Open (PPO) covers inpatient acute hospital stays with no coinsurance and a $600 daily copay for days 1 to 4, with no copay for days 5 to 95. Inpatient psychiatric stays are also covered with no coinsurance and a $400 daily copay for days 1 to 5, with no copay for days 6 to 90. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Assist Open (PPO) covers outpatient hospital services with a range of no copay to a $500 copay and 20% coinsurance, and ambulatory surgical center services for a $250 copay and no coinsurance. Patients will pay a $115 copay per stay and 20% coinsurance for observation services, a $25 copay and no coinsurance for outpatient substance abuse sessions, and no copay or coinsurance for outpatient blood services.
Partial Hospitalization See details
Wellcare Assist Open (PPO) covers partial hospitalization services with a $105.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Assist Open (PPO) covers Medicare-approved ground and air ambulance services with a $325 copay and no coinsurance per service, subject to prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Wellcare Assist Open (PPO) covers emergency services with a $115 copay and urgent care with a $35 copay, both with no coinsurance and 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 Assist Open (PPO) covers primary care physician visits with no copay and no coinsurance, and telehealth services with a $0 to $35 copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, and mental health services require a $25 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services offered by Wellcare Assist Open (PPO) are partially covered, featuring no copay and no coinsurance for annual physical exams, fitness benefits, alternative therapies, remote access, and various screenings, though sub-services like health education, in-home safety assessments, and personal emergency response systems are not covered. Kidney disease education is covered with no copay and a 20% coinsurance.
Hearing Services See details
Wellcare Assist Open (PPO) offers partially covered hearing services, featuring a $25 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $500 annual maximum per ear, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Assist Open (PPO) partially covers vision services with no deductibles and no coinsurance, though other eye exam services are not covered. Routine eye exams are covered with no copay (with other covered exams requiring a copay of up to $25), and eyewear is covered with no copay up to a combined annual maximum benefit of $100.
Dental Services See details
Dental services are partially covered by Wellcare Assist Open (PPO), featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and other covered services up to a $1,000 annual limit. Non-covered services include orthodontics, implant services, maxillofacial prosthetics, and fixed or removable prosthodontics.
Home Infusion bundled Services See details
Wellcare Assist Open (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and miscellaneous drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Assist Open (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist Open (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Assist Open (PPO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance and no copay for lab services alongside a $0 to $50 copay for diagnostic tests. Radiological services include a $40 copay plus coinsurance for X-rays, a copay starting at $0 for diagnostic radiology, and a copay with at least 20% coinsurance for therapeutic radiology.
Home Health Services See details
Wellcare Assist Open (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Wellcare Assist Open (PPO) feature no coinsurance, and although some services are covered, specific programs like standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($25 copay), and Supervised Exercise Therapy for PAD ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Assist Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and days 71 to 100, and a $218 daily copay for days 21 to 70. Prior authorization is required, and while a prior three-day hospital stay is not needed for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Assist Open (PPO) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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