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Wellcare Simple Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple Open (PPO) in 2026, please refer to our full plan details page.
Wellcare Simple Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in OK. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Simple 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 Simple 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 Simple 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.
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 $615.00 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 $10100.00 (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 $10100.00 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 Simple Open (PPO)
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Drug Coverage
The Wellcare Simple Open (PPO) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 select care drugs are covered with no copay across all preferred and standard pharmacy options. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. You will pay a 25% coinsurance for Tier 3 preferred brand drugs and Tier 5 specialty drugs, while Tier 4 non-preferred drugs require a 36% coinsurance. Standard pharmacies and standard mail-order services are also available for Tier 1 and Tier 2 medications with copays starting as low as $5.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for primary care visits, home health services, and annual physical exams. For inpatient hospital care, members pay a $350 copay for days 1 to 5 of an acute stay and no copay for subsequent days, with no coinsurance required. Emergency room visits carry a $115 copay, while specialist visits and therapy sessions require a low $15 copay. In addition to core medical care, this plan provides robust ancillary benefits, including dental, vision, and hearing services with no copay for routine exams. Members benefit from a $1,000 annual hearing aid allowance per ear and a $300 annual eyewear allowance with no copay or coinsurance. Furthermore, over-the-counter items and chronic illness meal benefits are covered with no copay, while durable medical equipment and dialysis require no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple Open (PPO) covers inpatient hospital care with no coinsurance, requiring a $350 copay for days 1-5 of an acute stay and a $300 copay for days 1-5 of a psychiatric stay, with no copay for subsequent covered days. While acute stays offer up to 30 additional covered days at no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple Open (PPO) covers outpatient services with no coinsurance, including outpatient blood services which feature no copay, coinsurance, or deductible. Copays for other covered services include $0 to $280 for outpatient hospital services, $115 to $280 per stay for observation services, $225 for ambulatory surgical center services, and $25 for outpatient substance abuse sessions.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Simple Open (PPO) plan with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Simple Open (PPO) covers ground and air ambulance services with a $275 copay per service and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Simple Open (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent 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 Simple Open (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and opioid treatment require a $15 copay and no coinsurance. Mental health and psychiatric sessions have a $25 copay with no coinsurance, additional telehealth services range from a $0 to $40 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Simple Open (PPO) offers partially covered preventive services with no copay and no coinsurance for annual physical exams, fitness benefits, alternative therapies, and remote access technologies, though kidney disease education requires a 20% coinsurance and no copay. Uncovered sub-services under this plan include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling services.
Hearing Services See details
Hearing services are covered by Wellcare Simple Open (PPO), featuring Medicare-covered exams for a $15 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear annually, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Wellcare Simple Open (PPO) vision services are partially covered, featuring eye exams with a $0 to $15 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contact lenses and eyeglasses, has no copay and no coinsurance up to a combined maximum benefit of $300 per year.
Dental Services See details
Wellcare Simple Open (PPO) offers partially covered dental services, featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services. Prior authorization is required for most dental services, and maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple Open (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Wellcare Simple Open (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple Open (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay from specified manufacturers, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Simple Open (PPO) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $40 copay, while radiological services carry a $25 copay for X-rays and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Wellcare Simple Open (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple Open (PPO) covers Cardiac Rehabilitation Services with no coinsurance, but only some services are covered in practice. Specifically, cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $40 copay), pulmonary rehabilitation (with a $25 copay), and supervised exercise therapy for peripheral artery disease (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 61 to 100, a $218 daily copay for days 21 to 60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Simple Open (PPO), which provides over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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