A non-government entity
Wellcare Mutual of Omaha Simple Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Mutual of Omaha 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 Mutual of Omaha Simple Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Mutual of Omaha Simple Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in WA. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Wellcare Mutual of Omaha 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 Mutual of Omaha 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 Mutual of Omaha 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 $10000.00 (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 $10000.00 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 Mutual of Omaha Simple Open (PPO) plan has a $420 deductible for prescription drugs. After you meet your deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, there is no copay at preferred pharmacies and mail order pharmacies. Standard pharmacies have a $10 copay. For standard generic, preferred brand, and non-preferred drugs, you will pay coinsurance. Specialty tier drugs have no copay.
Additional Benefits
The Wellcare Mutual of Omaha Simple Open (PPO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays depending on the service. The plan also includes coverage for primary care, preventive, hearing, vision, and dental services with no or low copays for many services. Additional benefits include ambulance services, emergency care, and home health services, each with specific copays or coinsurance. The plan also covers other services such as acupuncture and over-the-counter items. However, some services like cardiac rehabilitation and certain home-based care options are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered. For acute care, you will pay a $400 copay for days 1-5, and no copay for days 6-90; for psychiatric care, you will pay a $465 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $500, observation services have a copay between $125 and $500, ASC services have a $250 copay, and both individual and group outpatient substance abuse sessions have a $40 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan, but requires prior authorization. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services. Ground and air ambulance services have a $300 copay, and there is no coinsurance. Transportation services to a health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage each have a $125 copay, while Urgently Needed Services has a $55 copay, and there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The Wellcare Mutual of Omaha Simple Open (PPO) plan covers primary care physician services and chiropractic services with no copay, while occupational therapy services have a $25 copay. Physician specialist services and physical therapy/speech-language pathology services have a $25 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions, and other healthcare professionals have a copay between $0 and $25. Additional telehealth benefits have a copay between $0 and $55, and Opioid Treatment Program Services have a $25 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services with a copay for some services, and also covers alternative therapies, and therapeutic massage with no copay. Kidney Disease Education Services have a 20% coinsurance, and other preventive services are covered with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a maximum benefit of $500 per ear. Prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Wellcare Mutual of Omaha Simple Open (PPO) plan covers vision services, including eye exams with a copay of $0 to $25, and eyewear with a combined maximum benefit of $200 per year and no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered with no copay, limited to one visit per year.
Dental Services See details
The Wellcare Mutual of Omaha Simple Open (PPO) plan covers Medicare Dental Services with a $25 copay, and other dental services including oral exams, dental x-rays, and other diagnostic dental services with no copay. This plan also covers prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Orthodontic services are covered up to a maximum of $1,500 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare Mutual of Omaha Simple Open (PPO) plan, with prior authorization required. 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 Mutual of Omaha Simple Open (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and requires authorization, Prosthetic Devices, and Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, and lab services. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a $75 copay.
Home Health Services See details
Home Health Services are covered under the Wellcare Mutual of Omaha 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 not covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan. While the plan covers the Cardiac Rehabilitation Services benefit, none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan, but prior authorization is required. For days 1-20 and 61-100, there is no copay, while days 21-60 have a copay of $214.
Other Services See details
The Wellcare Mutual of Omaha Simple Open (PPO) plan covers acupuncture with no copay and over-the-counter items with no copay, up to $91 every three months. However, the plan does not cover 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, or Self-Directed Personal Assistance Services.
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