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Wellcare Patriot Giveback Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Patriot 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 Patriot Giveback Open (PPO) in 2026, please refer to our full plan details page.
Wellcare Patriot Giveback Open (PPO) is a PPO 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 Patriot Giveback Open (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Patriot 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 Patriot 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 $75.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Wellcare Patriot Giveback Open (PPO).
Additional Benefits
The Wellcare Patriot Giveback Open (PPO) plan offers comprehensive healthcare coverage with no copay for primary care visits, mental health services, and annual physical exams. For inpatient hospital stays, members pay a $400 daily copay for days 1 through 6 and no copay for days 7 through 90, while specialist visits require a $35 copay. Emergency room visits carry a $115 copay, which is waived if you are admitted within 24 hours, and urgent care is available with a $40 copay. This plan features no copay for routine dental, vision, and hearing exams, including up to a $1,000 annual limit for dental care and a $500 yearly allowance per ear for hearing aids. Diagnostic labs, diabetic supplies, and home health services also require no copay, while dialysis and durable medical equipment are covered with a 20% coinsurance. Additionally, skilled nursing facility stays are highly affordable, requiring no copay for the first 20 days of care.
Inpatient Hospital See details
Wellcare Patriot Giveback Open (PPO) partially covers inpatient hospital services, excluding additional days, upgrades, and non-Medicare-covered stays. Acute stays require no coinsurance and a $400 daily copay for days 1 to 6 (no copay for days 7 to 90), while psychiatric stays require no coinsurance and a $350 copay per stay, both requiring prior authorization.
Outpatient Services See details
Wellcare Patriot Giveback Open (PPO) covers outpatient hospital services with no copay and 30% coinsurance, and observation services with a $115 copay per stay and 30% coinsurance. Ambulatory surgical center services require a $250 copay and no coinsurance, while outpatient substance abuse and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Patriot Giveback Open (PPO) with a $105.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Patriot Giveback Open (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Patriot 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 both 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 Patriot Giveback Open (PPO) covers primary care physician visits and mental health services with no copay and no coinsurance. Specialist visits, physical, occupational, and speech therapies, and podiatry services require a $35 copay and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Wellcare Patriot Giveback Open (PPO) provides partially covered preventive services with no copays and no coinsurance for annual physical exams, fitness benefits, and select screenings, though kidney disease education requires a 20% coinsurance with no copay. Numerous additional benefits are not covered, including health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, telemonitoring, and counseling.
Hearing Services See details
Wellcare Patriot Giveback Open (PPO) offers hearing services featuring a $35 copay and no coinsurance for Medicare-covered exams, while routine exams and fitting evaluations have no copay and no coinsurance. Hearing aids are partially covered with no copay or coinsurance up to a $500 maximum per ear yearly, but OTC hearing aids and specific prescription types like inner, outer, and over-the-ear models are not covered.
Vision Services See details
Wellcare Patriot Giveback Open (PPO) partially covers vision services, offering one routine eye exam per year with no copay and no coinsurance, though prior authorization is required. Other eye exam services and all eyewear, including contact lenses and eyeglasses, are not covered.
Dental Services See details
Wellcare Patriot Giveback Open (PPO) dental services are partially covered, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and most comprehensive services up to a $1,000 annual limit. Implant services, maxillofacial prosthetics, and orthodontics are not covered, and prior authorization is required for most services.
Home Infusion bundled Services See details
Wellcare Patriot Giveback Open (PPO) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Covered Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Patriot Giveback Open (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Patriot Giveback Open (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic therapeutic shoes, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, though prior authorization is required for these benefits and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Patriot Giveback Open (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic lab services feature no copay or coinsurance, diagnostic procedures and tests range from a $0 to $100 copay with no coinsurance, outpatient X-rays require a $50 copay, and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home health services are covered by Wellcare Patriot Giveback Open (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Patriot Giveback Open (PPO) offers coverage for cardiac rehabilitation services with no coinsurance, though some services are not covered. These uncovered services include standard cardiac rehabilitation (which carries a $30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($20 copay).
Skilled Nursing Facility (SNF) See details
Wellcare Patriot Giveback Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and 71 through 100, and a $218 daily copay for days 21 through 70. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Other services are partially covered by Wellcare Patriot Giveback Open (PPO), featuring a chronic illness meal benefit with no copay and no coinsurance, though a referral is required. Acupuncture and over-the-counter (OTC) items are not covered.
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