A non-government entity
Wellcare Mutual of Omaha Premium Enhanced Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Mutual of Omaha Premium Enhanced 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 Premium Enhanced Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Mutual of Omaha Premium Enhanced Open (PPO) is a PPO 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 Mutual of Omaha Premium Enhanced 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 Premium Enhanced 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 Premium Enhanced Open (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $96.00. 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 $3000.00 (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 $3000.00 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:
Sign up for Wellcare Mutual of Omaha Premium Enhanced Open (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Mutual of Omaha Premium Enhanced Open (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $420. In the initial coverage phase, you will pay the following costs. For preferred generic drugs and specialty tier drugs, there is no copay at a preferred pharmacy or preferred mail order, while standard pharmacies and standard mail orders have a $10 copay. Standard generic drugs, preferred brand drugs, and non-preferred drugs have 25%, 50%, and 28% coinsurance, respectively. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Wellcare Mutual of Omaha Premium Enhanced Open (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $200 copay per admission. Many outpatient services, including substance abuse and blood services, come with no copay, while others have copays ranging from $0 to $200. Emergency services have a $140 copay, and ambulance services have a $300 copay. Primary care visits and many preventive services, like annual physical exams, have no copay. The plan also includes coverage for hearing exams, prescription hearing aids, and vision services like eye exams and eyewear with no copay. Dental services cover a variety of procedures with no copay, and orthodontic services are covered up to a $1,500 maximum per year.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $200 copay per admission or stay for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with no coinsurance. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $200, observation services with a copay between $140 and $200, and ambulatory surgical center services with a $200 copay. Outpatient substance abuse services, including individual and group sessions, have no copay. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $130 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Mutual of Omaha Premium Enhanced Open (PPO) plan. Ground and Air Ambulance Services each have a $300 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $140.00, while Urgently Needed Services has no copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits. Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a $0 copay. Occupational Therapy Services has a $0 copay and no coinsurance. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for an annual physical exam with no copay, and additional preventive services which require prior authorization, and may have a 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 an EKG following a Welcome Visit. Other services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Adult Day Health Services, Nutritional/Dietary Benefit, 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 are not covered. Alternative Therapies, Therapeutic Massage, Remote Access Technologies, and Fitness Benefit are covered with no copay.
Hearing Services See details
The Wellcare Mutual of Omaha Premium Enhanced Open (PPO) plan covers hearing exams with no copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids are covered up to $350 per ear annually with no copay.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses, and upgrades, has no copay, and a combined maximum benefit of $100 per year applies to both in-network and out-of-network services.
Dental Services See details
Dental Services include coverage for Medicare Dental Services and Other Dental Services. Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Oral and Maxillofacial Surgery, Restorative Services, Endodontics, Periodontics, and Adjunctive General Services are covered with no copay. Orthodontic Services are covered up to a $1,500 maximum per year, and all other services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. 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 by the Wellcare Mutual of Omaha Premium Enhanced Open (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay for diagnostic procedures, tests, and lab services, and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay, and Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Wellcare Mutual of Omaha Premium Enhanced 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 covered, but specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and others are not covered. There is a copay for some of these services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Mutual of Omaha Premium Enhanced Open (PPO) plan, but require prior authorization. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture with no copay, Over-the-Counter (OTC) Items with no copay, and a meal benefit with no copay. 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved