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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Dual Access Open (PPO D-SNP) is a PPO D-SNP plan offered by Wellcare Health Insurance Company of Oklahoma, Inc. available for the 2026 plan year to people living in Select Counties in OK. CMS star rating not available for 2026.
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 $28.20. 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
Health deductible: same as Medicare's Part B deductible.
This plan has a $455.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 Open (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
The Wellcare Dual Access Open (PPO D-SNP) plan features an annual drug deductible of $455. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively for a one-month supply at a preferred pharmacy, with no copay required for a three-month supply filled via preferred mail order. Additionally, Tier 6 select care drugs are highly accessible with no copay across all pharmacy and mail-order options. Tier 3 preferred brands require a 20% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply. For Tier 4 non-preferred drugs, you will pay a flat copay starting at $100 for a one-month supply at both standard and preferred pharmacies. Choosing preferred pharmacies and mail-order services generally offers the lowest out-of-pocket costs for your prescription medications under this plan.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) offers comprehensive medical coverage, featuring an inpatient hospital copay of $1,490 per admission and no copay with a 20% coinsurance for most outpatient, specialist, and diagnostic services. Emergency care is available with a $115 copay, which is waived if you are admitted within 24 hours, while urgently needed care requires a $40 copay. Additionally, the plan provides home health services and select preventive care with no copay and no coinsurance. For extra healthcare needs, members benefit from dental coverage up to a $4,000 yearly limit and hearing aid coverage up to $1,000 per ear with no copay and no coinsurance. Vision services feature an annual $300 eyewear allowance, while routine exams and medical equipment generally require a 20% coinsurance and no copay. The plan also includes valuable extras like no-copay over-the-counter items and up to 36 one-way trips per year for plan-approved transportation.
Inpatient Hospital See details
Wellcare Dual Access Open (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,490 copay per admission and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access Open (PPO D-SNP) covers outpatient services with no copays and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for hospital, surgical center, and substance abuse services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Dual Access Open (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Wellcare Dual Access Open (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance, providing up to 36 one-way trips per year to plan-approved locations, though transportation to any other health-related location is not covered.
Emergency Services See details
Wellcare Dual Access Open (PPO D-SNP) 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 covered up to a $50,000 maximum benefit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access Open (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, though prior authorization is required for most of these benefits. Telehealth services are covered with a $0 to $40 copay and 20% coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Dual Access Open (PPO D-SNP) offers partially covered preventive services, featuring annual physical exams, fitness benefits, personal emergency response systems, alternative therapies, and remote access technologies with no copay and no coinsurance. Kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome visit EKGs are covered with no copay and a 20% coinsurance. Uncovered services include health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Wellcare Dual Access Open (PPO D-SNP) hearing services are partially covered with no deductible, offering one annual routine exam with no copay and 20% coinsurance, and one annual fitting evaluation with no copay and no coinsurance. Prescription hearing aids are covered up to $1,000 per ear annually with no copay and no coinsurance, but prior authorization is required, and OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Dual Access Open (PPO D-SNP) provides partially covered vision services, which exclude other eye exam services but include one routine eye exam per year with no copay and a 20% coinsurance. Covered eyewear has no copay, a 20% coinsurance for contact lenses, and a combined annual limit of $300 with no deductibles.
Dental Services See details
Dental services are partially covered by Wellcare Dual Access Open (PPO D-SNP), featuring no copay and no coinsurance for most preventive and comprehensive dental care up to a $4,000 yearly limit. Medicare-covered dental services require a 20% coinsurance and no copay, while implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access Open (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered 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 Open (PPO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, is covered by Wellcare Dual Access Open (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access Open (PPO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, though prior authorization is required. Covered benefits include diagnostic procedures, lab services, therapeutic and diagnostic radiological services, and outpatient X-rays.
Home Health Services See details
Wellcare Dual Access Open (PPO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to access these services.
Cardiac Rehabilitation Services See details
Wellcare Dual Access Open (PPO D-SNP) offers Cardiac Rehabilitation Services with no copay, but only some services are covered in practice as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access Open (PPO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and 71 to 100, a $218 daily copay for days 21 to 70, and prior authorization is required with no prior three-day hospital stay needed.
Other Services See details
Wellcare Dual Access Open (PPO D-SNP) provides partial coverage for other services, offering over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture and meal benefits are not covered. Covered OTC items include nicotine replacement therapy and naloxone, which are eligible for reimbursement with no maximum benefit limit.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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