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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 2025, 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 2025.
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 $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 $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:
Sign up for Wellcare Simple Open (PPO)
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Drug Coverage
The Wellcare Simple Open (PPO) plan has a $420 deductible for prescription drugs. After you meet your deductible, you will enter the initial coverage phase where you pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. For specialty drugs, there is no copay. The plan also has an enhanced alternative drug benefit.
Additional Benefits
The Wellcare Simple Open (PPO) plan provides comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with varying copays, and ambulance services with a $275 copay. Emergency services have a $125 copay, and primary care physician visits have no copay. The plan also includes coverage for hearing, vision, and dental services, with no copays for routine eye exams, eyewear, and most dental services. Additionally, this plan offers benefits such as home health services with no copay, and skilled nursing facility (SNF) services with no copay for certain days. It also covers home infusion services, dialysis, and medical equipment. The plan provides an over-the-counter (OTC) allowance, and covers preventive services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric services, are covered under the Wellcare Simple Open (PPO) plan. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-5, and no copay for days 6-90; additional days (91-999) have no copay. Inpatient Hospital Psychiatric services have a $370 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a copay between $0 and $325, observation services with a copay between $125 and $325, ambulatory surgical center services with a $275 copay, and outpatient substance abuse services with a $40 copay for individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple Open (PPO) plan, but requires prior authorization. You will pay a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple Open (PPO) plan. Ground and air ambulance services have a $275 copay, and transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Wellcare Simple Open (PPO) plan with a $125 copay and no coinsurance, and Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Open (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $25 copay. The plan also covers physician specialist services with a $25 copay. Mental health specialty services and psychiatric services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits range from no copay to a $40 copay, and opioid treatment program services have a $25 copay.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered preventive services with no copay, an annual physical exam with no copay, and other preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Kidney Disease Education Services have a 20% coinsurance. The plan does not cover health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, 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, or counseling services.
Hearing Services See details
Hearing services include hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered. The plan provides a maximum of $1,000 per year for prescription hearing aids.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, and a combined maximum benefit of $400 per year applies to both in-network and out-of-network services.
Dental Services See details
The Wellcare Simple Open (PPO) plan covers Medicare Dental Services with a $25 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, 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 $5,000 maximum benefit, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare Simple Open (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while the plan has a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple Open (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Wellcare Simple Open (PPO) plan. The plan has a 20% coinsurance for Durable Medical Equipment and Prosthetic Devices, as well as 20% coinsurance for Medicare-covered Medical Supplies and Diabetic Therapeutic Shoes/Inserts, with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $25, and lab services with no copay. Radiological services are also covered, with a copay up to $325 for diagnostic services, a 20% coinsurance for therapeutic services, and a $25 copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered by the Wellcare 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 Simple Open (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20 and days 51-100, but there is a $214 copay for days 21-50.
Other Services See details
The Wellcare Simple Open (PPO) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $169 every three months. Acupuncture, Meal Benefit, 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, and Self-Directed Personal Assistance Services are not covered.
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