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Wellcare Giveback Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Giveback Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Giveback Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Giveback 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 Giveback 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 Giveback 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 Giveback 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. Additionally, this plan comes with a Part B Premium reduction of $72.60. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $395.00 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 $10000.00 (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 $10000.00 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 Giveback Open (PPO) plan has a $395.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and mail order, but a $10 copay at standard pharmacies. Specialty tier drugs have no copay. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Wellcare Giveback Open (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have a mix of copays and coinsurance. The plan also covers primary care with no copay, along with preventive, hearing, vision, and dental services, all with varying cost-sharing. Additional benefits include coverage for ambulance, emergency, and home health services, as well as medical equipment, dialysis, and diagnostic services. However, some services like acupuncture, certain therapies, and specific equipment are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $400 for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric services have a copay of $350 for days 1-5, and no copay for days 6-90. Additional days, non-Medicare covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a 20% coinsurance and a copay between $0 and $400, and observation services with a 20% coinsurance and a $110 copay. The plan also covers ambulatory surgical center (ASC) services with a $250 copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Giveback Open (PPO) plan, but requires prior authorization. You will have a copay of $80 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Giveback Open (PPO) plan. Ground and Air Ambulance Services have a $280 copay, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Wellcare Giveback Open (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, and Urgently Needed Services have a $40 copay; all have no coinsurance. Worldwide Urgent Coverage has a $110 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Giveback Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. It also covers physician specialist services, mental health specialty services, and physical therapy and speech-language pathology services, all with a $35 copay. The plan also offers additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $35 copay. Podiatry services are not covered.
Preventive Services See details
The Wellcare Giveback Open (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Alternative Therapies, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), with a $0 copay, and kidney disease education services with a 20% coinsurance. Other services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The Wellcare Giveback Open (PPO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay for 1 visit per year, and fitting/evaluation for hearing aids with no copay for 1 visit per year. Prescription hearing aids are covered up to $350 per ear, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Wellcare Giveback Open (PPO) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with no copay, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, up to a combined maximum of $200 per year. Routine eye exams have no copay and are limited to one per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, fluoride treatment with no copay, other preventive dental services with no copay, restorative services with 20% coinsurance, adjunctive general services with 20% coinsurance, endodontics with 20% coinsurance, periodontics with 20% coinsurance, prosthodontics (removable) with 20% coinsurance, prosthodontics (fixed) with 20% coinsurance, and oral and maxillofacial surgery with 20% coinsurance. Orthodontic services have a maximum benefit of $1000 per year, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance may apply, ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Giveback Open (PPO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $400, and Outpatient X-Ray Services have a copay of $50. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Giveback 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 by the Wellcare Giveback Open (PPO) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. The plan's cost-sharing includes a copay, but the specific amount is not detailed in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20 and days 61-100, there is no copay, while days 21-60 have a copay of $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Wellcare Giveback Open (PPO) plan does not cover acupuncture, meal benefits, or dual eligible SNPs with highly integrated services. Over-the-counter (OTC) items are covered with no copay, up to a maximum of $45 every three months. Other services are not covered, including 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.
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