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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 Select Counties in OK. 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 $42.20. 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 $13300.00 (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 $13300.00 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 the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you may have a reduced premium. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Part D covered drugs, though you may still pay for excluded drugs.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers comprehensive coverage, including inpatient hospital stays with a $1870 copay per admission and outpatient services with a 20% coinsurance. Emergency services have a $110 copay, while urgently needed services have a $45 copay, and primary care services have a 20% coinsurance. Additional benefits include preventive services such as annual physical exams at no cost, hearing exams and hearing aids with no copay, and vision services with a 20% coinsurance for exams and eyewear. Dental services are covered with no copay for many services, and home health services are covered with no cost. The plan also provides coverage for home infusion, medical equipment, and diagnostic services, with varying copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Wellcare Dual Access Open (PPO D-SNP) plan with a copay of $1870 per admission or stay; however, additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric care are not covered. Prior authorization is required.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a 20% coinsurance and no copay, and observation services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services, individual sessions for outpatient substance abuse, and group sessions for outpatient substance abuse have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Outpatient blood services have a 20% coinsurance and a waived deductible of three pints.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Access Open (PPO D-SNP) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance, and Transportation Services have no copay. Transportation Services to any health-related location are limited to 36 one-way trips per year.
Emergency Services See details
Emergency Services are covered under 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, while Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $50,000 maximum plan benefit, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. For these services, you will pay 20% coinsurance, though additional telehealth benefits may have a copay between $0 and $45.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other services like kidney disease education, glaucoma screening, and diabetes self-management training with 20% coinsurance. The plan does not cover health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission 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, and counseling services. Personal emergency response systems, alternative therapies, remote access technologies, home and bathroom safety devices and modifications, and fitness benefits are covered with no copay.
Hearing Services See details
Hearing services include coverage for hearing exams and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay and no coinsurance, while prescription hearing aids have a maximum benefit of $1,000 per ear every year, and the plan covers the costs with no copay.
Vision Services See details
Vision services include eye exams, with a 20% coinsurance and no copay, and eyewear, with a 20% coinsurance. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum plan benefit coverage amount of $400 per year.
Dental Services See details
Dental services are covered, with 20% coinsurance for Medicare dental services. Other services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Orthodontic services have a $3,000 maximum benefit per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
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 is covered by the Wellcare Dual Access Open (PPO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefits, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts all have a 20% coinsurance.
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, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray 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 not covered by the Wellcare Dual Access Open (PPO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits 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.
Other Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers Over-the-Counter (OTC) Items with no copay. Other services, including 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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