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Wellcare Dual Access Sync Open (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access Sync 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 Sync Open (PPO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access Sync 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 out of 5 stars in 2026.
It's important to know that Wellcare Dual Access Sync 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 Sync 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 Sync 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 Sync Open (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.40. 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 $400.00 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:
Sign up for Wellcare Dual Access Sync Open (PPO D-SNP)
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Drug Coverage
The Wellcare Dual Access Sync Open (PPO D-SNP) plan features a $400 drug deductible and offers tiered cost-sharing options to help manage prescription expenses. For Tier 1 preferred generics, copays start at $18 for a one-month supply at preferred pharmacies, with no copay for a three-month supply through preferred mail order. Tier 2 generics start with a $19 copay for a one-month supply and also feature no copay for a three-month supply when utilizing preferred mail order. Tier 3 preferred brands and Tier 5 specialty drugs both require a 25% coinsurance across pharmacy options. Tier 4 non-preferred drugs have a $100 copay for a one-month supply at both preferred and standard pharmacies. Notably, Tier 6 select care drugs are fully covered with no copay for one-, two-, or three-month fills at all participating pharmacies and mail-order services.
Additional Benefits
The Wellcare Dual Access Sync Open (PPO D-SNP) offers comprehensive medical coverage, featuring no copay and a 20% coinsurance for outpatient services, primary care, and diagnostic tests. Inpatient hospital stays require a $1,895 copay per admission with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Skilled nursing facility care is also covered with no copay for days 1 to 20, though a $218 daily copay applies for days 21 to 70. This plan also provides robust supplemental benefits, including dental care up to a $3,000 annual limit and eyewear up to a $300 annual limit with no copays or coinsurance. Additionally, members receive routine hearing aid fittings and up to two prescription hearing aids per year with no copay, alongside 24 one-way transportation trips to approved locations. Preventive services, home health care, and over-the-counter items are also available with no copay or coinsurance to support your daily wellness.
Inpatient Hospital See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers inpatient hospital acute and psychiatric services with a $1,895 copayment per admission or stay and no coinsurance, though prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services—with no copay and a 20% coinsurance. Prior authorization is required for several of these benefits, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Wellcare Dual Access Sync Open (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Wellcare Dual Access Sync Open (PPO D-SNP), requiring prior authorization for both. Medicare-covered ground and air ambulance services require a 20% coinsurance with no copay, while transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers emergency services with a $115 copay and urgent care with a $40 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance. Podiatry services feature no copay and no coinsurance, while chiropractic services are partially covered because other chiropractic services are not covered. Telehealth benefits are also available with a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) provides partially covered preventive services, offering annual physical exams, fitness benefits, and personal emergency response systems with no copay and no coinsurance. Kidney disease education and select screenings are covered with no copay and a 20% coinsurance, though sub-services like health education, weight management, and nutritional therapy are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Dual Access Sync Open (PPO D-SNP) with no plan deductible. Routine hearing exams are covered once annually with a 20% coinsurance and no copay, while fitting evaluations and up to two prescription hearing aids per year have no copay or coinsurance. Prescription hearing aids are covered up to $750 per ear annually, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Dual Access Sync Open (PPO D-SNP), which offers one annual routine eye exam with no copay and 20% coinsurance, though other eye exam services are not covered. Eyewear is covered up to a $300 combined annual limit with no deductible, featuring contact lenses with no copay and 20% coinsurance, and eyeglasses, lenses, frames, and upgrades with no copay and no coinsurance.
Dental Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and 20% coinsurance, alongside other covered preventive and comprehensive services with no copay or coinsurance up to a $3,000 annual limit. Prior authorization is required for most services, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access Sync Open (PPO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellcare Dual Access Sync Open (PPO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Dual Access Sync Open (PPO D-SNP) with no copay and a 20% coinsurance. Covered services include lab work, diagnostic procedures, therapeutic radiology, and outpatient X-rays, all of which require prior authorization.
Home Health Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Wellcare Dual Access Sync Open (PPO D-SNP) with no copay, but only some services are covered in practice as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no copay for days 1 to 20 and days 71 to 100, though a $218 daily copay applies for days 21 to 70. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) provides partial coverage for Other Services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance, though acupuncture is not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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