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Wellcare Patriot Giveback Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Patriot Giveback Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Patriot Giveback Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Patriot Giveback Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in OR. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Patriot Giveback Open (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Patriot Giveback 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 Patriot Giveback 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. Additionally, this plan comes with a Part B Premium reduction of $50.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $200.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7400.00 (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 $7400.00 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
Prescription drugs are not covered by Wellcare Patriot Giveback Open (PPO).
Additional Benefits
The Wellcare Patriot Giveback Open (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays that vary. Emergency and urgent care services have a copay, and primary care visits have no copay. Preventive services have no copay, while hearing, vision, and dental services have copays and coinsurance. The plan also covers medical equipment, home health services, and other services like acupuncture and over-the-counter items. Skilled nursing facility stays have a copay, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Wellcare Patriot Giveback Open (PPO) plan. For Inpatient Hospital-Acute, you will pay a $500 copay for days 1-5, and no copay for days 6-90; Inpatient Hospital Psychiatric has a $400 copay for days 1-5, and no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $400, observation services with a copay between $125 and $400, and ambulatory surgical center services with a $200 copay. Outpatient substance abuse services, including individual and group sessions, have no copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Patriot Giveback Open (PPO) plan, with a copay of $105.00. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Patriot Giveback Open (PPO) plan. Ground and Air Ambulance Services have a $175 copay, with no coinsurance, but Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage each have a copay of $125, $55, and $125, respectively, and no coinsurance. Worldwide Urgent Coverage has a copay of $125, and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
For the Wellcare Patriot Giveback Open (PPO) plan, primary care services are covered with no copay, and chiropractic services are covered with no copay. Occupational therapy, physical therapy, and speech-language pathology services have a $25 copay. Physician specialist services have a $25 copay. Mental health and psychiatric individual and group sessions have no copay, and other health care professionals have a copay between $0 and $25. Additional telehealth benefits have a copay between $0 and $55. Opioid treatment program services have a $25 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Additional preventive services, as well as kidney disease education services, are covered, but have coinsurance of 20%. Some preventive services, such as health education, in-home safety assessments, and personal emergency response systems, are not covered.
Hearing Services See details
Hearing services include hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $1000 per year, and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Patriot Giveback Open (PPO) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $25, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $200 per year.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $25 copay, and Other Dental Services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with 40% coinsurance. Orthodontic services are covered up to a $2,000 annual maximum, and Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Patriot Giveback Open (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Patriot Giveback Open (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Patriot Giveback Open (PPO) plan, with a copay for some services. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $400, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Patriot Giveback Open (PPO) plan with no copay and no coinsurance. However, 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 Patriot Giveback Open (PPO) plan. While the plan mentions that this benefit is covered, the specific services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Patriot Giveback Open (PPO) plan, but require prior authorization. For days 1-20 and days 41-100, there is no copay; for days 21-40, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the Wellcare Patriot Giveback Open (PPO) plan, acupuncture is covered with no copay, but requires prior authorization and is limited to 24 treatments per year. Over-the-counter items are covered with no copay, and the plan offers up to $100 every three months, including nicotine replacement therapy and Naloxone. Some other services are not covered, including meal benefits, and several other services.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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