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Wellcare Assist Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Assist 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 Assist 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 Assist 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 Assist Open (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.30. 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 $500.00 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 Assist Open (PPO) plan has a $500 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $19 copay at a preferred pharmacy, while preferred brand drugs have a $100 copay. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Assist Open (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, with no copay for days 6-90. Outpatient services have copays that vary by service. The plan also covers ambulance services, emergency services, and primary care with copays for some services. Preventive services, hearing, vision, and dental services are included with copays or coinsurance for certain services. The plan also covers home health services, skilled nursing facilities, and some medical equipment with no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered by the Wellcare Assist Open (PPO) plan. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient Services are covered by the Wellcare Assist Open (PPO) plan, including outpatient hospital services with a copay of $0-$300, observation services with a copay of $125-$300, ambulatory surgical center (ASC) services with a $250 copay, outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Assist Open (PPO) plan. This benefit requires prior authorization and has a copay of $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Assist Open (PPO) plan. Ground and Air Ambulance Services have a $300 copay, while Transportation Services to a plan-approved health-related location have no copay for up to 24 one-way trips per year, and Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency and Urgent Coverage, are covered under the Wellcare Assist Open (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $35 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and physician specialist services with a $25 copay. Mental health specialty services, including individual and group sessions, have a $25 copay. Other health care professional services have a copay between $0 and $25, and psychiatric services, including individual and group sessions, also have a $25 copay. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay between $0 and $35, and Opioid Treatment Program Services have a $25 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Wellcare Assist Open (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services have a copay, and some services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 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. The plan also covers Kidney Disease Education Services with a 20% coinsurance. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay; prescription hearing aids are covered up to $1500 per ear per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. Routine hearing exams and fitting/evaluation for hearing aids are limited to one visit per year, and prescription hearing aids (all types) are limited to two visits per year.
Vision Services See details
The Wellcare Assist Open (PPO) plan covers vision services, including eye exams with a copay between $0 and $25, and eyewear with no copay. Routine eye exams are covered with no copay, and are limited to 1 per year. Eyewear has a combined maximum benefit of $400 per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $25 copay. Other services like oral exams, dental x-rays, cleanings, fluoride treatments, and restorative services have no copay, while orthodontics has a $5,000 maximum benefit. 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. 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 under the Wellcare Assist Open (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Wellcare Assist Open (PPO) plan. Durable Medical Equipment (DME) and Prosthetic Devices have a 20% coinsurance, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Wellcare Assist Open (PPO) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a copay between $0 and $25, and Lab Services with no copay. Diagnostic Radiological Services have a copay of at most $300, while Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist Open (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Assist Open (PPO) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20 and 51-100, there is no copay, while days 21-50 have a copay of $214.
Other Services See details
The Wellcare Assist Open (PPO) plan covers Over-the-Counter (OTC) items with no copay and a maximum benefit coverage amount of $130 every three months. Meal benefits are also covered with no copay and a doctor referral is required, while acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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