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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 2025 to people living in Statewide - Indiana. 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 $8950.00 (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 $8950.00 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) plan features a $615 annual prescription drug deductible. You will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 (Select Care Drugs) are highly affordable, featuring no copay across all standard and preferred pharmacies. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 (Preferred Brand) and Tier 5 (Specialty) drugs both carry a 25% coinsurance, while Tier 4 (Non-Preferred) drugs require a 35% to 36% coinsurance depending on your pharmacy choice. Utilizing preferred network pharmacies and mail-order options will help you secure the lowest out-of-pocket costs with this plan.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers robust coverage with no copays for primary care visits, home health services, and annual preventive physicals. For other medical needs, members pay predictable copays with no coinsurance, such as a $20 copay for specialists, a $130 copay for emergency services, and daily inpatient hospital copays of $370 to $375 for the first five days. Diagnostic labs and routine X-rays are also available with no copays. Supplemental care is highly affordable, featuring no copays or coinsurance for routine hearing exams, routine vision exams with a $300 eyewear allowance, and comprehensive dental care up to a $5,000 annual limit. For specialized needs, dialysis and durable medical equipment require a 20% coinsurance with no copay, while prescription hearing aids are covered up to $750 per ear with no copay. Additionally, over-the-counter items are covered via reimbursement with no copay or coinsurance.
Inpatient Hospital See details
Wellcare Simple Open (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $375 copay for days 1 through 5 of acute stays and a $370 copay for days 1 through 5 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, while upgrades, non-Medicare-covered stays, and additional inpatient psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Simple Open (PPO) with no coinsurance, featuring copays ranging from $0 to $325 for outpatient hospital services, $130 to $325 per stay for observation services, and $250 for ambulatory surgical center visits. Outpatient substance abuse sessions require a $40 copay, while outpatient blood services are available with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Wellcare Simple Open (PPO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Wellcare Simple Open (PPO) covers ground and air ambulance services with a $275.00 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, trips 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 urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency and urgent services are partially covered with a $130 copay and no coinsurance up to a $50,000 maximum benefit, though 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, and specialist visits for a $20 copay and no coinsurance. Additional services like physical, occupational, and speech therapy have a $15 copay and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services under Wellcare Simple Open (PPO) are partially covered, offering annual physicals, alternative therapies, memory fitness, and remote access technologies with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Uncovered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, tobacco cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Simple Open (PPO) partially covers hearing services, offering Medicare-covered exams for a $20 copay and no coinsurance, and annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay and no coinsurance, while OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aid types are not covered.
Vision Services See details
Wellcare Simple Open (PPO) provides partially covered vision services, offering one routine eye exam per year and eyewear options with no copay, no coinsurance, and no deductible. While other eye exam services are not covered, members receive up to a $300 combined annual benefit for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Wellcare Simple Open (PPO) provides partially covered dental services with a $20 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other preventive and comprehensive care up to a $5,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Wellcare Simple Open (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require a coinsurance of 0% to 20%.
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 medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Simple Open (PPO) covers diagnostic and radiological services with no coinsurance for diagnostic services, no copay for lab services, and a $0 to $25 copay for diagnostic tests. Diagnostic radiological services feature a $0 minimum copay, outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Wellcare Simple Open (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple Open (PPO) offers Cardiac Rehabilitation Services with no coinsurance, but in practice, only some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. These non-covered rehabilitation services carry copays ranging from $25 to $50.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellcare Simple Open (PPO) with no coinsurance and requires prior authorization, with no prior three-day hospital stay required. There is no copay for days 1 through 20 and days 51 through 100, a $218 copay for days 21 through 50, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellcare Simple Open (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance via reimbursement. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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