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Wellcare Simple Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Simple Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Simple Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Simple 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 Simple 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 Simple 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 Simple 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $3450.00 (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 $3450.00 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:
Sign up for Wellcare Simple Open (PPO)
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Drug Coverage
The Wellcare Simple Open (PPO) plan has a $420.00 deductible for prescription drugs. After the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will pay no copay for preferred generic drugs at a preferred pharmacy, while you will pay 25% coinsurance for standard generic drugs at either a preferred or standard pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays require a copay, while outpatient services have copays that vary by service. Emergency services have copays, and primary care and preventive services are covered, with some services having no copay. The plan includes coverage for hearing, vision, and dental services, each with specific copays or no copays for certain services. Other benefits include home infusion, dialysis, medical equipment, and diagnostic services, often with coinsurance. The plan also covers skilled nursing facility stays and offers other services such as acupuncture and over-the-counter items, with specific limitations and prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $425 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $400 copay for days 1-5, and no copay for days 6-90. Additional days, non-Medicare-covered stays, and upgrades for both are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $400, Observation Services with a copay between $140 and $400, Ambulatory Surgical Center (ASC) Services with a $250 copay, and Outpatient Substance Abuse Services with a copay of $25 for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Simple 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 Simple Open (PPO) plan. Ground and Air Ambulance Services each have a $325 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Wellcare Simple Open (PPO) plan with a $140 copay and no coinsurance. Urgently Needed Services have a $65 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Open (PPO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services and Chiropractic Services have no copay, while Physician Specialist Services and Physical Therapy/Speech Therapy services have a $30 copay.
Preventive Services See details
The Wellcare Simple Open (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, but may have a copay depending on the service. Kidney disease education services are covered with 20% coinsurance.
Hearing Services See details
The Wellcare Simple Open (PPO) plan covers hearing exams for a $30 copay, routine hearing exams with no copay for 1 visit every year, and fitting/evaluation for hearing aids with no copay for 1 visit every year. Prescription hearing aids are covered with a maximum benefit of $750 per ear every year, and prescription hearing aids of all types have no copay for 2 visits every year, while prescription hearing aids for inner ear, outer ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$30, and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, up to a combined maximum of $200 per year. Routine eye exams have no copay, but are limited to one visit per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery, all with no copay. Orthodontic Services are covered up to a maximum of $1500 per year. Prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Simple Open (PPO) plan, and prior authorization is required. The plan has a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple Open (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
The Wellcare Simple Open (PPO) plan covers Durable Medical Equipment (DME) with 20% coinsurance and also covers Prosthetics, Medical Supplies, and Diabetic Equipment. Prosthetics and Medical Supplies have 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance, while Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. 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 Outpatient X-Ray Services have a $25 copay. Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple Open (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Simple Open (PPO) plan, but the plan does not cover any of the sub-services. There is a copay for this benefit, but the exact amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Open (PPO) plan, but require prior authorization. For days 1-20, there is no copay, a $214 copay for days 21-40, and no copay for days 41-100.
Other Services See details
The Wellcare Simple Open (PPO) plan covers acupuncture with no copay, but requires prior authorization and is limited to 24 treatments per year. Over-the-counter items are covered with no copay up to $120 every three months, and includes nicotine replacement therapy and Naloxone coverage. Meal benefits, Dual Eligible SNPs, 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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