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Wellcare Giveback Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 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 Giveback Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Giveback Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in LA. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Giveback 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 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 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 $75.50. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $190.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $420.00 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 $11300.00 (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 $11300.00 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 Giveback Open (PPO) plan has a $420 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have a 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. However, your premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Wellcare Giveback Open (PPO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a daily copay, while outpatient services have copays depending on the service, and preventive services are often available with no copay. The plan also covers services like primary care, hearing, vision, and dental, with specific copays or no copay depending on the service. Additional benefits include coverage for ambulance services, emergency services, and home health services with no copay. You'll also find coverage for medical equipment, diagnostic services, and skilled nursing facilities, but some of these services may involve coinsurance or require prior authorization. The plan also includes a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $302 per day for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $350 per day for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the Wellcare Giveback Open (PPO) plan, including outpatient hospital services with a copay between $0 and $500, observation services with a copay between $110 and $500, and ambulatory surgical center services with a $250 copay. Outpatient substance abuse services have a copay of $40 for individual and group sessions, while outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Giveback Open (PPO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Giveback Open (PPO) plan. Ground and Air Ambulance Services have a $275 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 all have a copay of $110, while Urgently Needed Services has a copay of $45; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Giveback Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $45 copay, and mental health specialty services with a $40 copay for both individual and group sessions. This plan also includes a $40 copay for physical therapy and speech-language pathology services, and a $45 copay for opioid treatment program services. Additionally, this plan covers additional telehealth benefits with a copay between $0 and $45.
Preventive Services See details
Preventive Services includes Medicare-covered services with no copay, an annual physical exam with no copay, and additional services that may have a copay. Additional preventive services include glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
The Wellcare Giveback Open (PPO) plan covers hearing exams for a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay, up to one visit per year. This plan provides up to $350 per year for prescription hearing aids, but does not cover prescription hearing aids for the inner ear, outer ear, or over the ear, nor does it cover OTC hearing aids.
Vision Services See details
The Wellcare Giveback Open (PPO) plan covers vision services, including eye exams with a copay ranging from $0 to $45 and eyewear with no copay. Routine eye exams are covered with no copay for one visit every year, and eyewear has a combined maximum benefit of $100 per year.
Dental Services See details
The Wellcare Giveback Open (PPO) plan covers Medicare Dental Services with a $45 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. However, restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 Giveback Open (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices and Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying coinsurance and copay based on the specific service. Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $40, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $350, Therapeutic Radiological Services with at least 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback 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 generally covered by the Wellcare Giveback Open (PPO) plan, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation, Medicare-covered Pulmonary Rehabilitation, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD), and Additional Cardiac Rehabilitation Services are not covered. There is a copay for covered services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will have no copay for days 1-20, a $214 copay for days 21-60, and no copay for days 61-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Giveback Open (PPO) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $50 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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