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Wellcare Premium Ultra Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Premium Ultra Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Premium Ultra Open (PPO) 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 Premium Ultra Open (PPO) is a PPO plan offered by Health Net Life Insurance Company available for the 2026 plan year to people living in Select counties in OR. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Premium Ultra 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 Premium Ultra 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 Premium Ultra Open (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $160.00. 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 has a $250.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 $6500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6500.00 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 $8700.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $8700.00 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 Premium Ultra Open (PPO)
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Drug Coverage
The Wellcare Premium Ultra Open (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, members pay no copay when using preferred pharmacies or preferred mail-order options. When filling Tier 1 and Tier 2 prescriptions at standard pharmacies, copays start as low as $5 and $10 for a one-month supply, while Tier 6 drugs maintain no copay. Higher-tier medications on this plan require coinsurance instead of flat copays. Tier 3 preferred brands and Tier 5 specialty drugs both carry a 25% coinsurance, whereas Tier 4 non-preferred drugs require a 41% coinsurance. Specialty drugs are restricted to a one-month supply and are available at both preferred and standard pharmacies.
Additional Benefits
The Wellcare Premium Ultra Open (PPO) plan offers robust coverage for essential medical needs, featuring no copays for primary care visits and a low $25 copay for specialist consultations. Inpatient hospital stays require daily copays for the first seven days but transition to no copays for longer stays, while outpatient services are covered with no coinsurance and varying copays. Emergency room visits carry a $130 copay, and urgent care services are available for a $50 copay, with both fees waived if you are admitted to the hospital within 24 hours. For supplemental care, members benefit from no copays on routine vision and hearing exams, which include annual allowances of up to $200 for eyewear and $750 per ear for prescription hearing aids. Preventive dental care features no copays, while comprehensive dental services require a 40% coinsurance up to a $2,000 annual limit. Additionally, home health care is covered with no copays, while durable medical equipment and dialysis services generally require a 20% coinsurance.
Inpatient Hospital See details
Wellcare Premium Ultra Open (PPO) partially covers inpatient hospital services with no coinsurance, featuring a $425 daily copay for days 1 to 7 of acute stays and a $265 daily copay for days 1 to 7 of psychiatric stays, with no copay for days 8 to 90. Upgrades, additional days, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Wellcare Premium Ultra Open (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $425 and observation services with a $130 to $425 copay per stay. Ambulatory surgical center services require a $200 copay, outpatient substance abuse sessions carry a $25 copay, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Wellcare Premium Ultra Open (PPO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellcare Premium Ultra Open (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, requiring prior authorization. For transportation benefits, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Wellcare Premium Ultra Open (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 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 $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Premium Ultra Open (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $25 copay and no coinsurance. Chiropractic care is partially covered with a $15 copay and no coinsurance, excluding other chiropractic services, whereas podiatry services are not covered.
Preventive Services See details
Wellcare Premium Ultra Open (PPO) provides partially covered preventive services, including annual physicals, select screenings, memory fitness, and alternative therapies with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Supplemental services such as health education, weight management programs, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services under the Wellcare Premium Ultra Open (PPO) are partially covered with no deductible, featuring a $25 copay and no coinsurance for Medicare-covered exams, and routine exams, fittings, and prescription hearing aids with no copay and no coinsurance. Prescription hearing aids are covered up to $750 per ear annually, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Premium Ultra Open (PPO), featuring no deductible, no coinsurance, and copays ranging from $0 to $25 for covered eye exams. Routine annual eye exams and eyewear, including contacts and eyeglasses, have no copay under a $200 annual limit, though other eye exam services are not covered.
Dental Services See details
Wellcare Premium Ultra Open (PPO) offers partially covered dental services, featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive care. Covered comprehensive services require no copay and 40% coinsurance up to a $2,000 annual maximum, but prosthodontics, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Premium Ultra Open (PPO) covers Home Infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin is covered under this benefit with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Premium Ultra Open (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Premium Ultra Open (PPO) covers medical equipment, including durable medical equipment (DME), medical supplies, and prosthetics, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Wellcare Premium Ultra Open (PPO) with prior authorization required. There is no copay for lab, diagnostic, and diagnostic radiological services, though diagnostic procedures and therapeutic radiological services carry a 20% coinsurance, and outpatient X-rays require a $50 copay.
Home Health Services See details
Wellcare Premium Ultra Open (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Premium Ultra Open (PPO) features no coinsurance for Cardiac Rehabilitation Services, indicating some services are covered, though standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($35 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellcare Premium Ultra Open (PPO) with no coinsurance, featuring no copay for days 1 to 20 and days 51 to 100, and a $218 daily copay for days 21 to 50. Prior authorization is required, a prior three-day hospital stay is not, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Premium Ultra Open (PPO) offers partial coverage for Other Services, featuring acupuncture with no copay and no coinsurance for up to 24 treatments per year, though prior authorization is required. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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