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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 2025, 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 2025.
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 $26.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $13300.00 (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 $13300.00 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) plan has a $420 deductible for prescription drugs. After the deductible, you will pay the following costs for drugs in each tier. For preferred generic drugs, you will have no copay at preferred and mail order pharmacies and a $10 copay at standard pharmacies. For standard generic drugs, you will pay 25% coinsurance. For preferred brand drugs, you will pay 43% coinsurance. For non-preferred drugs, you will pay 28% coinsurance. For specialty tier drugs, you will have no copay. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Wellcare Giveback Open (PPO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay, while outpatient services have copays that vary by service. The plan also includes coverage for emergency services, primary care with no copay for many services, preventive services with no copay for many services, hearing and vision services, and dental services with no copay for many services, as well as coverage for medical equipment, dialysis, and home health services. This plan also covers ambulance services, partial hospitalization, and cardiac rehabilitation. Diagnostic and radiological services are covered, with copays or coinsurance depending on the service. The plan does not cover certain services such as acupuncture, over-the-counter items, and other services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a copay of $450 for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a copay of $407 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $425, and observation services with a copay between $110 and $425. Ambulatory Surgical Center (ASC) Services have a $300 copay, and outpatient substance abuse services have a $25 copay per session. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Giveback Open (PPO) plan, with a copay of $80.00. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Giveback 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 under the Wellcare Giveback Open (PPO) plan have a $110 copay, while urgently needed services have a $45 copay; both have no coinsurance. Worldwide emergency coverage and worldwide urgent coverage have a $110 copay, and worldwide emergency transportation is not covered.
Primary Care See details
The Wellcare Giveback Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $50 copay, mental health specialty services with a $25 copay for individual and group sessions, other health care professional services with a copay between $0 and $50, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with a $50 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for an annual physical exam with no copay, as well as additional preventive services, kidney disease education services, and other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. The coinsurance for kidney disease education services is 20%.
Hearing Services See details
The Wellcare Giveback Open (PPO) plan covers hearing exams with a $50 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids are covered up to $750 per year.
Vision Services See details
The Wellcare Giveback Open (PPO) plan covers vision services, including eye exams with a copay of $0-$50, and eyewear with a combined maximum plan benefit of $100 per year. Routine eye exams have no copay, and eyewear benefits include contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, all with no copay.
Dental Services See details
The Wellcare Giveback Open (PPO) plan covers Medicare Dental Services with a $50 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. However, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Giveback Open (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
The Wellcare Giveback Open (PPO) plan covers medical equipment, including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Giveback Open (PPO) plan. 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 $425, and Outpatient X-Ray Services have a copay of $80. Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback Open (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Giveback Open (PPO) plan, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The plan has a copay for Cardiac Rehabilitation Services, but the copay amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Giveback Open (PPO) plan, but require prior authorization. For days 1-20 and 71-100, there is no copay, and for days 21-70, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefits, 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. No authorization or referral is required for these services.
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