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Wellcare Dual Access Open (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access Open (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Dual Access Open (PPO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access Open (PPO D-SNP) is a PPO D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Select Counties in Washington. This plan received an overall rating of 2.5 out of 5 stars in 2026.
It's important to know that Wellcare Dual Access Open (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Dual Access Open (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Dual Access Open (PPO D-SNP).
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 Dual Access Open (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.50. 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 $605.00 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 $13900.00 (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 $13900.00 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 Dual Access Open (PPO D-SNP) prescription drug plan features an annual drug deductible of $605. For Tier 1 preferred generics and Tier 2 generics, copays start as low as $18 and $19 respectively, with no copay for a three-month supply filled through preferred mail order. Select Care Drugs in Tier 6 also feature no copay at preferred pharmacies and through preferred mail order. Tier 3 preferred brand drugs require a copay starting at $47 for a one-month supply. Tier 4 non-preferred drugs require a 44% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply. Utilizing preferred pharmacies and preferred mail-order services offers the lowest out-of-pocket costs for your prescriptions.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers comprehensive medical coverage with varying cost-sharing structures depending on the service. For inpatient hospital stays, members pay a copayment of $2,230 per acute admission or $2,080 per psychiatric admission with no coinsurance. Outpatient services, primary care, and specialist visits generally require no copay and a 20% coinsurance, while emergency room visits have a $115 copay. Many preventive services, home health visits, and routine podiatry care are available with no copay and no coinsurance. Additionally, the plan features dental, vision, and hearing benefits that typically require no copay, though some services may require a 20% coinsurance. Other benefits like acupuncture, chronic illness meals, and over-the-counter items are also covered with no copay and no coinsurance.
Inpatient Hospital See details
Wellcare Dual Access Open (PPO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copayment per admission for acute stays and a $2,080 copayment per admission for psychiatric stays. Prior authorization is required for these services, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access Open (PPO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and substance abuse services.
Partial Hospitalization See details
Wellcare Dual Access Open (PPO D-SNP) covers partial hospitalization with no copay and a 20% coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Wellcare Dual Access Open (PPO D-SNP) partially covers ambulance and transportation services, featuring a 20% coinsurance and no copay for Medicare-covered ground and air ambulance services, which require prior authorization. Transportation services to plan-approved health-related locations or any other health-related locations are not covered.
Emergency Services See details
Wellcare Dual Access Open (PPO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered. Cost sharing for these services counts toward the plan-level deductible.
Primary Care See details
Wellcare Dual Access Open (PPO D-SNP) covers primary care, specialist, mental health, and therapy services with no copay and 20% coinsurance, while telehealth has a $0 to $40 copay and 20% coinsurance. Podiatry is covered with no copay and no coinsurance, and chiropractic services are partially covered with no copay and no coinsurance for routine care, though other chiropractic services are not covered.
Preventive Services See details
Wellcare Dual Access Open (PPO D-SNP) partially covers preventive services, offering annual physicals, fitness benefits, PERS, and alternative therapies with no copay and no coinsurance. Kidney disease education and other screenings like glaucoma exams feature no copay but require a 20% coinsurance, while health education, weight management, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Wellcare Dual Access Open (PPO D-SNP), featuring a 20% coinsurance and no copay for one routine hearing exam annually, and no copay for fitting evaluations. Prescription hearing aids are covered with no copay or coinsurance up to a $500 maximum benefit per ear every year, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Wellcare Dual Access Open (PPO D-SNP) covers one routine eye exam per year with no copay and a 20% coinsurance, though other types of eye exams are not covered. Covered eyewear options—including glasses with no copay or coinsurance, and contact lenses with a 20% coinsurance and no copay—are subject to a $100 combined annual limit with no deductibles.
Dental Services See details
Wellcare Dual Access Open (PPO D-SNP) offers partially covered dental services with no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other preventive and comprehensive dental services up to a $1,000 annual maximum. Prior authorization is required for covered services, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access Open (PPO D-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Under this plan, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Wellcare Dual Access Open (PPO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access Open (PPO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access Open (PPO D-SNP) covers diagnostic and radiological services with no copayment and a 20% coinsurance, subject to prior authorization. This coverage includes diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Wellcare Dual Access Open (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Access Open (PPO D-SNP) provides Cardiac Rehabilitation Services with no copay, though only some services are covered in practice as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access Open (PPO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and 71 to 100, a $218 daily copay for days 21 to 70, and prior authorization is required.
Other Services See details
Wellcare Dual Access Open (PPO D-SNP) offers acupuncture limited to 12 treatments yearly, over-the-counter items, and chronic illness meals with no copay and no coinsurance, though prior authorization or referrals may be required. Highly integrated services for dual eligibles and other miscellaneous services are not covered under this plan.
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