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Wellcare Giveback Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 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 Giveback Open (PPO) in 2026, please refer to our full plan details page.
Wellcare Giveback Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in OR and WA. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Giveback 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 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 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 $10.00. You must continue to pay paying your reduced 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. 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 $13700.00 (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 $13700.00 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 Giveback Open (PPO) prescription drug plan features an annual drug deductible of $615. You can save on medication costs with no copay for Tier 1 preferred generics and Tier 2 generics when filled at a preferred pharmacy or through preferred mail order. Additionally, Tier 6 select care drugs are covered with no copay at both standard and preferred pharmacies. For higher-tier medications, you will pay a coinsurance instead of a flat copay. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance. If you choose to use standard pharmacies, Tier 1 preferred generics have a $5 copay and Tier 2 generics have a $10 copay for a one-month supply.
Additional Benefits
The Wellcare Giveback Open (PPO) plan offers affordable coverage with no copay and no coinsurance for primary care doctor visits, telehealth services, and routine preventive care. Specialist visits require a $50 copay, while inpatient hospital stays carry a $475 daily copay for the first five days. Outpatient surgical services and emergency care are also covered with flat copays and no coinsurance. Beneficiaries can also access routine dental, vision, and hearing exams with no copay, plus allowances for eyewear and prescription hearing aids. Home health services feature no copay and no coinsurance, whereas durable medical equipment and dialysis services require a 20% coinsurance. Skilled nursing facility stays are partially covered, offering no copay for the first 20 days of your stay.
Inpatient Hospital See details
Wellcare Giveback Open (PPO) inpatient hospital benefits are partially covered, offering acute care with no coinsurance, a $475 daily copay for days 1 to 5, and no copay for days 6 to 90. Psychiatric hospital stays also feature no coinsurance, with a $400 daily copay for days 1 to 5 and no copay for days 6 to 90, though upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Giveback Open (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $500 and observation services with a $115 to $500 copay per stay. Ambulatory surgical center services carry a $300 copay with no coinsurance, outpatient substance abuse sessions require a $25 copay with no coinsurance, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Wellcare Giveback Open (PPO) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Wellcare Giveback Open (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Giveback Open (PPO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Giveback Open (PPO) offers primary care physician services and select telehealth benefits with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Physical, occupational, and speech therapy services have a $35 copay with no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
Wellcare Giveback Open (PPO) offers partially covered preventive services, featuring no copay and no coinsurance for annual physical exams, alternative therapies, memory fitness, and routine screenings, though kidney disease education requires a 20% coinsurance with no copay. Several supplemental benefits are not covered, including health education, weight management, nutritional or dietary benefits, and in-home safety assessments.
Hearing Services See details
Wellcare Giveback Open (PPO) provides partially covered hearing services, with Medicare-covered exams requiring a $50 copay and no coinsurance, while annual routine exams and fittings have no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Giveback Open (PPO), which excludes other eye exam services but offers routine eye exams and eyewear with no copay, no coinsurance, and no deductible. Routine eye exams are limited to one per year, and eligible eyewear—including contacts, frames, and lenses—is covered up to a combined maximum benefit of $100 annually.
Dental Services See details
Wellcare Giveback Open (PPO) partially covers dental services, offering Medicare-covered dental care for a $50 copay and no coinsurance, and preventive services with no copay and no coinsurance. However, restorative services, endodontics, periodontics, prosthodontics, implants, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Giveback Open (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Giveback Open (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Giveback Open (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with prior authorization required. Covered DME, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts feature no copay and a 20% coinsurance, while diabetic supplies are covered with no copay.
Diagnostic and Radiological Services See details
Wellcare Giveback Open (PPO) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic procedures, lab services, and diagnostic radiological services feature no copay, while a 20% coinsurance applies to diagnostic procedures and therapeutic radiological services, lab services require coinsurance, and outpatient X-rays require a $50 copay and coinsurance.
Home Health Services See details
Home health services are covered under the Wellcare Giveback Open (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Giveback Open (PPO) with no coinsurance, but some services are not covered, including standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for PAD ($20 copay).
Skilled Nursing Facility (SNF) See details
Wellcare Giveback Open (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, though additional days beyond the Medicare-covered limit are not covered. For covered stays, there is no copay for days 1–20 and 71–100, a $218 daily copay for days 21–70, and prior authorization is required.
Other Services See details
Other Services are not covered under Wellcare Giveback Open (PPO), as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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