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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 2025, 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 All counties in KY. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $49.60. 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 $590.00 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 $14000.00 (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 $14000.00 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) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs associated with your prescriptions, but the exact costs are not listed in this summary. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D will be $49.60.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers a range of benefits with varying costs. It covers inpatient hospital stays with a high copay, and outpatient services with 20% coinsurance. Emergency services have a copay, while primary care and other services like chiropractic and hearing exams have no copay. This plan also includes coverage for preventive services, vision, dental, and home health services, often with no copay. Additional benefits include transportation, medical equipment, and home infusion services, with a mix of copays and coinsurance. The plan offers a $750 allowance per ear for hearing aids and covers OTC items and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a copay of $2185 and $2036 per stay, respectively. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include a 20% coinsurance for outpatient hospital services, observation services, and outpatient blood services. Outpatient hospital services have no copay. Individual and group sessions for outpatient substance abuse, and ambulatory surgical center services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Access Open (PPO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to plan-approved health-related locations have no copay, with up to 24 one-way trips per year via rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan with a $110 copay, and no coinsurance. Urgently Needed Services have a $45 copay, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $110 copay, and no coinsurance, however Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers primary care physician services with a 20% coinsurance. Chiropractic services, including routine care, are covered with no copay, and up to 12 visits per year. Occupational therapy, physician specialist, mental health specialty, podiatry, other health care professional, psychiatric, physical therapy and speech-language pathology services are covered with a 20% coinsurance. The plan also offers additional telehealth benefits with a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services are covered with a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional services are covered. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visits are covered with a 20% coinsurance. The plan also covers Personal Emergency Response Systems, Fitness Benefits, Remote Access Technologies, Home and Bathroom Safety Devices, and In-Home Support Services with no copay. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered, including hearing exams and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and routine hearing exams have at most 20% coinsurance, while prescription hearing aids have a maximum plan benefit coverage of $750 per ear every year.
Vision Services See details
Vision Services include eye exams with no copay and 20% coinsurance, and eyewear with a 20% coinsurance. Routine eye exams have no copay, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all have no copay.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare Dental Services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery are also covered with no copay. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Dual Access Open (PPO D-SNP) 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 has a 20% coinsurance and requires prior authorization. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts each have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic procedures/tests and radiological services have a coinsurance of at most 20%, while lab services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access Open (PPO D-SNP) 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, but the plan does not cover any specific sub-services. There is coinsurance for covered services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan offers Over-the-Counter (OTC) Items with no copay, and a Meal Benefit with no copay when a doctor referral is required. Acupuncture, 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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