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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 2026, please refer to our full plan details page.
Wellcare Simple Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2026 to people living in Select counties in OR. This plan received an overall rating of 3 out of 5 stars in 2026.
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 has a $150.00 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 $13200.00 (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 $13200.00 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 Simple 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 generic and Tier 2 generic drugs when filled at a preferred pharmacy or through preferred mail order. Additionally, Tier 6 select care drugs are highly accessible with no copay at both standard and preferred pharmacies. For brand-name and specialty medications, your costs are determined by coinsurance. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 36% coinsurance. Standard pharmacies and standard mail-order options are also available for Tier 1 and Tier 2 drugs with copays starting as low as $5.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For specialist visits and physical therapy, members pay a predictable $30 copay, while emergency room visits carry a $115 copay with no coinsurance. Inpatient hospital stays require a $600 copay for the first four days, followed by no copay for additional Medicare-covered days. Routine dental, vision, and hearing exams are available with no copay, though annual coverage limits apply to supplemental benefits like hearing aids and eyewear. Durable medical equipment, diagnostic tests, and dialysis services generally require a 20% coinsurance with no copay, while diabetic supplies are covered with no copay. Medicare Part B insulin is capped at a $35 copay, helping members manage essential prescription medication costs.
Inpatient Hospital See details
Wellcare Simple Open (PPO) covers inpatient hospital services with no coinsurance, although upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute inpatient stays require a $600 copay for days 1 through 4 and no copay for days 5 through 95, while psychiatric stays require a $400 copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Wellcare Simple Open (PPO) covers outpatient services, with outpatient hospital services requiring a $0 to $500 copay and 30% coinsurance, and observation services costing a $115 copay per stay and 30% coinsurance. Ambulatory surgical center visits carry a $475 copay with no coinsurance, outpatient substance abuse sessions have a $25 copay with no coinsurance, and outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Simple Open (PPO) covers partial hospitalization services with a $105.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple Open (PPO) covers Medicare-approved ground and air ambulance services with a $325 copay per trip and no coinsurance, though prior authorization is required. While transportation services are technically covered, trips to plan-approved or any health-related locations are not covered in practice.
Emergency Services See details
Wellcare Simple Open (PPO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring no coinsurance and 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 Simple Open (PPO) features primary care physician visits with no copay and no coinsurance, alongside specialist, physical therapy, and occupational therapy services for a $30 copay and no coinsurance. Chiropractic care is partially covered with a $15 copay and no coinsurance, excluding other chiropractic services, while podiatry services are not covered.
Preventive Services See details
Wellcare Simple Open (PPO) covers key preventive services, including annual physical exams, fitness benefits, alternative therapies, and various screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. The benefit is partially covered because supplemental services such as health education, weight management programs, nutritional benefits, and in-home support are not covered.
Hearing Services See details
Hearing services covered by Wellcare Simple Open (PPO) include Medicare-covered exams for a $30 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual maximum per ear, but OTC, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Simple Open (PPO), offering no coinsurance and no copay for one annual routine eye exam and eyewear, including contacts and eyeglasses, up to a $100 annual combined limit. Other eye exam services are not covered under this plan, and prior authorization is required for covered services.
Dental Services See details
Wellcare Simple Open (PPO) offers partially covered dental services, which include Medicare-covered dental services for a $30 copay and no coinsurance, and preventive services like cleanings and exams for no copay and no coinsurance. However, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Simple Open (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Simple Open (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple Open (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Simple Open (PPO) and require prior authorization. Members pay no copay for lab services, diagnostic procedures, and diagnostic radiology, but therapeutic radiology and diagnostic tests require a 20% coinsurance, and outpatient X-rays carry a $50 copay.
Home Health Services See details
Wellcare Simple Open (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple Open (PPO) covers some cardiac rehabilitation services with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. These non-covered services require copayments ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Wellcare Simple Open (PPO) covers Skilled Nursing Facility (SNF) stays with no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and days 61 to 100, while days 21 to 60 require a daily copay of $218.
Other Services See details
Other Services under the Wellcare Simple Open (PPO) are partially covered, offering acupuncture with no copay and no coinsurance for up to 24 treatments per year, though prior authorization is required. Over-the-Counter (OTC) items, meal benefits, and other additional services are not covered.
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