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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 2025, 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 2025.
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 $26.20. 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 $590.00 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 $14000.00 (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 $14000.00 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) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs, but the specific costs for each tier are not listed. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D is $26.20. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan provides a range of benefits with varying cost-sharing. You'll find coverage for inpatient hospital stays with a copay, and outpatient services, including blood services, with 20% coinsurance. Ambulance and transportation services are covered, with ground and air ambulance at 20% coinsurance and transportation services with no copay for up to 12 one-way trips per year. This plan also includes coverage for emergency services with a copay, as well as primary care and chiropractic services with coinsurance or no copay. Preventive services, such as annual physical exams, are covered with no copay, and vision and dental services are offered with coinsurance and copays. Hearing services, including routine hearing exams and hearing aids, are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, the copay is $1620 per admission or stay, while for Inpatient Hospital Psychiatric, the copay is $1937 per admission or stay; additional days, and non-Medicare covered stays for both are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a 20% coinsurance and no copay, observation services with a 20% coinsurance, Ambulatory Surgical Center (ASC) services with a 20% coinsurance, outpatient substance abuse services with a 20% coinsurance, and outpatient blood services with a 20% coinsurance. The blood services also have a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Dual Access Open (PPO D-SNP) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellcare Dual Access Open (PPO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and Transportation Services have no copay. Transportation Services to any health-related location are limited to 12 one-way trips per year. Transportation Services to any health-related location are covered.
Emergency Services See details
Emergency Services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan with a $110 copay and no coinsurance. Urgently Needed Services have a $45 copay and no coinsurance, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $110 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers primary care physician services with 20% coinsurance, and chiropractic services with no copay. The plan also covers occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services, all with varying coinsurance.
Preventive Services See details
Preventive Services include coverage for an annual physical exam with no copay, and additional preventive services. Additional preventive services include coverage for Fitness Benefit and Alternative Therapies with no copay, while services like Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance. Other services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, and more are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids, with Routine Hearing Exams and Fitting/Evaluation for Hearing Aids covered annually with no copay and a coinsurance of at most 20% for routine hearing exams; Prescription Hearing Aids (all types) are covered with no copay and a maximum benefit of $1,000 per ear every year. Inner ear, outer ear, and over the ear prescription hearing aids, as well as OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance and a $0 copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams have no copay and are limited to one per year. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan's dental services include coverage for Medicare dental services with 20% coinsurance. Other dental services such as oral exams, dental x-rays, and other diagnostic services have no copay; however, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum benefit of $1500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan, with prior authorization required. Insulin has 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 Dual Access Open (PPO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Supplies also have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered, including diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures and tests, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of at most 20%, while lab services have a coinsurance of at most 20% and no copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any specific services. There is coinsurance for covered services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes acupuncture with no copay and a limit of 12 treatments per year, over-the-counter (OTC) items with no copay, and meal benefits with no copay and a doctor referral. However, 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, and Self-Directed Personal Assistance Services are not covered.
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