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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 ME. 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 $21.70. 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 $380.00 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) prescription drug plan has an annual drug deductible of $380. Tier 6 Select Care Drugs are highly accessible with no copay for any pharmacy or mail-order delivery. Tier 1 Preferred Generic and Tier 2 Generic medications are also highly affordable, starting at an $18 and $19 copay respectively for a one-month supply, and feature no copay when ordering a three-month supply through preferred mail order. For brand-name and specialty medications, Tier 3 Preferred Brand and Tier 5 Specialty Tier drugs require a 25% coinsurance. Tier 4 Non-Preferred Drugs carry a $100 copay for a one-month supply at both standard and preferred pharmacies. Understanding these copayment and coinsurance structures helps you accurately budget your healthcare costs under this plan.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers comprehensive medical coverage, featuring no copay and a 20% coinsurance for primary care, outpatient services, and diagnostic tests. For inpatient hospital stays, members pay a $1,990 copay per admission with no coinsurance, while emergency room visits carry a $115 copay. Skilled nursing facility care is also covered with no copay for the first 20 days and a $218 daily copay for days 21 through 70. Supplemental benefits include dental care with no copay and no coinsurance for preventive services up to a $2,000 annual limit, alongside vision care that offers eyeglasses up to a $200 annual limit with no coinsurance. Hearing services feature routine exams with a 20% coinsurance and up to $1,000 per ear annually for prescription hearing aids with no copay or coinsurance. Additionally, members benefit from home health services, over-the-counter items, and chronic illness meals with no copay and no coinsurance.
Inpatient Hospital See details
Wellcare Dual Access Open (PPO D-SNP) partially covers inpatient hospital services, requiring a $1,990 copayment per admission or stay and no coinsurance for Medicare-covered acute and psychiatric care. Prior authorization is required, and the plan does not cover additional days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Wellcare Dual Access Open (PPO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copayment and a 20% coinsurance. Prior authorization is required for most of these services, and there is no deductible for outpatient blood 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 for this benefit.
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. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Wellcare Dual Access Open (PPO D-SNP) with a $115 copay and no coinsurance, while urgent care has a $40 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access Open (PPO D-SNP) covers primary care, specialist, therapy, psychiatric, and mental health services with no copay and a 20% coinsurance, while telehealth services require a $0.00 to $40.00 copay and 20% coinsurance. Podiatry is not covered, and chiropractic care is only partially covered, excluding routine and other chiropractic services.
Preventive Services See details
Wellcare Dual Access Open (PPO D-SNP) covers preventive services, including annual physical exams, alternative therapies, memory fitness, and remote access technologies with no copay and no coinsurance. Other covered services, such as kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome-visit EKGs, have no copay and a 20% coinsurance. Several supplemental preventive benefits, including health education, weight management, and in-home safety assessments, are not covered.
Hearing Services See details
Wellcare Dual Access Open (PPO D-SNP) hearing services are partially covered, offering annual routine hearing exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $1,000 per ear every year with no copay or coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Dual Access Open (PPO D-SNP) with no copays, though other eye exam services are not covered. Routine eye exams (limited to one per year) and contact lenses require prior authorization and a 20% coinsurance, while eyeglasses are covered with no coinsurance up to a combined $200 annual limit.
Dental Services See details
Wellcare Dual Access Open (PPO D-SNP) partially covers dental services with no copay and 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and most comprehensive services up to a $2,000 annual maximum. Implant services, maxillofacial prosthetics, and orthodontics are not covered.
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. Covered 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 durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these medical equipment benefits, 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 tests, diagnostic procedures, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Wellcare Dual Access Open (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Access Open (PPO D-SNP) covers Cardiac Rehabilitation Services with no copay, but some services are not covered in practice. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access Open (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and days 71 through 100, and a $218 daily copay for days 21 through 70. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Dual Access Open (PPO D-SNP) partially covers other services, providing over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and other additional services are not covered under this benefit.
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