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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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $6750.00 (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 $6750.00 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) Medicare prescription drug plan features an annual drug deductible of $615. Under this plan, you will benefit from no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications when filled through preferred pharmacies or preferred mail-order services. Additionally, Tier 6 (Select Care Drugs) are highly affordable with no copay across all standard and preferred pharmacy or mail-order options. For higher-tier medications, the plan transitions from copays to coinsurance. Tier 3 (Preferred Brand) and Tier 5 (Specialty Tier) drugs require a 25% coinsurance, while Tier 4 (Non-Preferred Drug) prescriptions carry a 36% coinsurance across all pharmacy types. Standard pharmacies and standard mail-order options are also available for generic tiers, featuring low copays ranging from $5 to $30 depending on the supply.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers affordable access to core medical services, featuring no copay for primary care visits and a $30 copay for specialist consultations and therapy. Inpatient hospital stays require no coinsurance, with a $600 copay for days one through four of acute care and subsequent days covered with no copay. Emergency room visits carry a $130 copay, which is waived if you are admitted, while urgent care services require a $50 copay. This plan also provides strong preventive and supplemental benefits, including annual physicals, fitness programs, and routine vision and hearing exams with no copay. Routine dental care is covered up to a $1,500 annual limit with no copay, and prescription hearing aids are covered up to $750 per ear with no copay. Additionally, home health services are available with no copay, while durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple Open (PPO) covers inpatient hospital services with no coinsurance, requiring a $600 copay for days 1-4 of acute care and a $400 copay for days 1-5 of psychiatric care, with no copay for subsequent covered days. Prior authorization is required, and certain services like upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Simple Open (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $500 for outpatient hospital services and $130 to $500 per stay for observation services. Ambulatory surgical center services require a $250 copay with no coinsurance, outpatient substance abuse sessions carry a $25 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Wellcare Simple Open (PPO) with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Simple Open (PPO) covers ground and air ambulance services with a $325 copay and no coinsurance, with prior authorization required. For transportation benefits, some services are covered but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Wellcare Simple Open (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple Open (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, occupational therapy, and physical therapy require a $30 copay and no coinsurance. Mental health and psychiatric services have a $25 copay and no coinsurance, routine chiropractic care is partially covered with a $15 copay and no coinsurance, and podiatry services are not covered.
Preventive Services See details
Wellcare Simple Open (PPO) provides partially covered preventive services, offering annual physical exams, fitness benefits, alternative therapies, and screenings with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, though supplemental services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Wellcare Simple Open (PPO) covers Medicare-covered hearing exams with a $30 copay and no coinsurance, while annual routine exams and fitting evaluations have no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no copay or coinsurance up to a $750 annual maximum per ear, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Simple Open (PPO) with no deductible or coinsurance, offering one annual routine eye exam with no copay, while other eye exam services are not covered. Eyewear is covered with no copay up to a $200 combined annual limit, though prior authorization is required for both exams and eyewear.
Dental Services See details
Dental Services are partially covered under the Wellcare Simple Open (PPO) plan, featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive benefits up to a $1,500 annual limit. Sub-services that are not covered include implant services, orthodontics, maxillofacial prosthetics, and fixed or removable prosthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Wellcare Simple Open (PPO) with no copay, subject to prior authorization. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple Open (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple Open (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Simple Open (PPO) covers diagnostic and radiological services with prior authorization, where only the maximum copay applies for multiple services received on the same day. Diagnostic procedures require a 20% coinsurance with no copay, lab and diagnostic radiological services feature no copay, and outpatient X-rays carry a $50 copay, with coinsurance applying to laboratory, X-ray, and therapeutic radiological services.
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 copay and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple Open (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. 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 no coverage provided for days beyond the standard Medicare-covered limit.
Other Services See details
Wellcare Simple Open (PPO) provides partial coverage for other services, offering acupuncture with no copay and no coinsurance for up to 24 treatments per year, subject to prior authorization. Over-the-counter (OTC) items, meal benefits, and other supplemental services are not covered under this plan.
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