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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 2025, please refer to our full plan details page.
Wellcare Premium Ultra 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 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 $146.00. 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 $175.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $420.00 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 $6200.00 (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 $6200.00 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 Premium Ultra Open (PPO) plan has an enhanced alternative drug benefit. You must first satisfy a deductible of $420. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. For specialty tier drugs, there is no copay. For other tiers, you will pay coinsurance between 25% and 44%.
Additional Benefits
The Wellcare Premium Ultra Open (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. The plan also covers ambulance services with a $350 copay and emergency services with a $140 copay, as well as primary care and mental health services for a $25 copay. Preventive services, routine eye exams, and many dental services have no copay, and prescription hearing aids are limited. Home infusion, dialysis, and durable medical equipment have a coinsurance. Diagnostic and radiological services have no copay, and home health services are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-7 and no copay for days 8-90, while for Inpatient Hospital Psychiatric, you will pay a $265 copay for days 1-7 and no copay for days 8-90. Additional days and non-Medicare covered stays for both services are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $0 and $275, observation services with a copay between $140 and $275, Ambulatory Surgical Center (ASC) Services with a $200 copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Premium Ultra Open (PPO) plan, but requires prior authorization. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Premium Ultra Open (PPO) plan. Ground and Air Ambulance Services have a $350 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services has a $60 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Premium Ultra Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $25 copay, and physician specialist services with a $25 copay. The plan also covers mental health specialty services, psychiatric services, physical therapy, and speech-language pathology with a $25 copay, and additional telehealth benefits with a copay between $0 and $60. Opioid treatment program services are covered with a $25 copay, and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero-dollar preventive services, annual physical exams with no copay, and additional preventive services with copays for Fitness Benefits, Remote Access Technologies, and Alternative Therapies. Kidney Disease Education Services have a 20% coinsurance, while Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The Wellcare Premium Ultra Open (PPO) plan covers hearing exams for a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, but prescription hearing aids are limited to $750 per ear per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear, with prior authorization required. Routine eye exams have no copay, and you are eligible for 1 every year. Eyewear has a combined maximum plan benefit of $200 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $25 copay, Oral Exams and Dental X-Rays with no copay, and Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Fluoride Treatment with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery are covered with 40% coinsurance. Orthodontic Services are covered up to a $2,000 annual maximum. Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Wellcare Premium Ultra Open (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Premium Ultra Open (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services. Diagnostic Procedures/Tests have no copay and a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $275.00, 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 Premium Ultra Open (PPO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Premium Ultra Open (PPO) 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) services are covered, but require prior authorization. For days 1-20, there is no copay, for days 21-50, the copay is $214, and for days 51-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with a $0 copay, but is limited to 24 treatments per year and requires prior authorization. Over-the-Counter (OTC) Items, 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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