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Wellcare Low Premium Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Low Premium Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Low Premium Open (PPO) in 2026, please refer to our full plan details page.
Wellcare Low Premium 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 Low Premium 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 Low Premium 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 Low Premium Open (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $59.00. 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. 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 $12000.00 (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 $12000.00 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 Low Premium Open (PPO) Medicare prescription drug plan features an annual drug deductible of $615. Beneficiaries can save on medication costs with no copay for Tier 1 preferred generics and Tier 2 generics when using preferred pharmacies or preferred mail-order services. Tier 6 select care drugs also feature no copay across all standard and preferred pharmacy and mail-order options. For higher-tier medications, the plan requires a 25% coinsurance for Tier 3 preferred brands and Tier 5 specialty drugs. Tier 4 non-preferred drugs incur a 34% coinsurance at both preferred and standard pharmacies. Standard pharmacies and standard mail-order services are also available for generic tiers, with copays ranging from $5 to $30 depending on the supply.
Additional Benefits
The Wellcare Low Premium Open (PPO) plan offers robust coverage for essential medical needs, featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits, there is a $30 copay, while acute inpatient hospital stays require a $475 daily copay for the first five days and no copay for days six through 90. Emergency room services carry a $115 copay, which is waived if you are admitted, and ambulance services require a $325 copay. Routine dental, hearing, and vision exams are covered with no copay, alongside annual allowances of up to $500 per ear for prescription hearing aids and $100 for eyewear. For specialized medical needs, durable medical equipment and dialysis services require a 20% coinsurance with no copay. Please note that this plan does not cover acupuncture, over-the-counter items, or health-related transportation.
Inpatient Hospital See details
Wellcare Low Premium Open (PPO) partially covers inpatient hospital services with no coinsurance, as upgrades, additional days, and non-Medicare-covered stays are not covered. For acute inpatient stays, there is a $475 daily copay for days 1 through 5 and no copay for days 6 through 90, while psychiatric stays require a $400 daily copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Wellcare Low Premium Open (PPO) covers outpatient services with no coinsurance, featuring copays of $0 to $500 for outpatient hospital services and $115 to $500 per stay for observation services. Ambulatory surgical center services require a $350 copay with no coinsurance, outpatient substance abuse sessions have a $25 copay with no coinsurance, and outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Wellcare Low Premium Open (PPO) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Wellcare Low Premium Open (PPO) covers ground and air ambulance services with a $325 copay and no coinsurance per service, although prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Low Premium Open (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if you are 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, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Low Premium Open (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $30 copay and no coinsurance. Mental health and psychiatric services have a $25 copay and no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Wellcare Low Premium Open (PPO) offers partially covered preventive services, including annual physicals, fitness benefits, alternative therapies, and remote access technologies with no copay and no coinsurance, while kidney disease education carries a 20% coinsurance and no copay. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Wellcare Low Premium Open (PPO) partially covers hearing services, featuring a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Low Premium Open (PPO) offers partially covered vision services with no coinsurance and no deductibles, though other eye exam services are not covered. Routine eye exams have no copay, while other covered eye exams have a copay of up to $30, and eyewear is covered with no copay up to a $100 annual maximum.
Dental Services See details
Dental services are partially covered by Wellcare Low Premium Open (PPO), featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for covered preventive services. Restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implants, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Low Premium Open (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellcare Low Premium Open (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Low Premium Open (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with prior authorization required. There is no copay and a 20% coinsurance for DME, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies are covered with no copay.
Diagnostic and Radiological Services See details
Wellcare Low Premium Open (PPO) covers diagnostic and radiological services with prior authorization, offering lab and diagnostic radiological services with no copay. Diagnostic procedures and therapeutic radiological services require a 20% coinsurance and no copay, while outpatient X-rays have a $50 copay and coinsurance.
Home Health Services See details
Home health services are covered under the Wellcare Low Premium Open (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Low Premium Open (PPO) covers Cardiac Rehabilitation Services with no coinsurance, and though some services are covered, several sub-services are not covered in practice. Specifically, standard cardiac rehabilitation (which has a $30.00 copay), intensive cardiac rehabilitation ($40.00 copay), pulmonary rehabilitation ($25.00 copay), and supervised exercise therapy for peripheral artery disease ($20.00 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Low Premium Open (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 to 20 and days 61 to 100, while days 21 to 60 require a $218 daily copay, with additional days beyond the Medicare-covered limit not covered.
Other Services See details
Other services, including acupuncture, over-the-counter (OTC) items, and meal benefits, are not covered under the Wellcare Low Premium Open (PPO) plan.
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