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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 2026, 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 2026.
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 $38.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $380.00 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) prescription drug plan features an annual drug deductible of $380. For Tier 6 select care drugs, you will pay no copay regardless of the pharmacy or fill duration you choose. Additionally, Tier 1 preferred generic and Tier 2 generic medications offer no copay when filled through a three-month preferred mail-order service. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply. Tier 4 non-preferred drugs have copays starting at $100 for a one-month supply at both preferred and standard pharmacies. Choosing preferred pharmacies and mail-order services generally offers the lowest out-of-pocket costs for your prescriptions.
Additional Benefits
The Wellcare Assist Open (PPO) plan offers robust coverage with predictable cost-sharing, featuring no copay for primary care visits, annual physicals, and home health services. Specialist visits, urgent care, and outpatient diagnostic tests are highly affordable, generally requiring a low copay of $25 to $35. For more intensive care, emergency room visits carry a $130 copay, while inpatient hospital stays require a $350 daily copay for the first six days and no copay thereafter. This plan also provides excellent supplemental benefits, including no copay for routine dental, vision, and hearing exams, alongside annual allowances of $400 for eyewear and $1,000 per ear for prescription hearing aids. Additionally, members can take advantage of up to 12 one-way transportation trips per year to plan-approved locations with no copay. Standard medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Wellcare Assist Open (PPO) partially covers inpatient hospital services, providing acute and psychiatric stays with no coinsurance, a $350 daily copay for days 1 through 6, and no copay for days 7 through 90. Up to 60 additional acute days are covered with no copay, but prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Wellcare Assist Open (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $300 copay and observation services with a $130 to $300 copay per stay. Ambulatory surgical center services require a $250 copay, outpatient substance abuse sessions have a $25 copay, and outpatient blood services are covered with no copay, all with no coinsurance.
Partial Hospitalization See details
Wellcare Assist Open (PPO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Wellcare Assist Open (PPO) features a $300 copay and no coinsurance for ground and air ambulance services, while transportation services are partially covered. Covered transportation includes up to 12 one-way trips per year to plan-approved locations with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under Wellcare Assist Open (PPO) are covered with a $130 copay and no coinsurance, while urgently needed services require a $35 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under the Wellcare Assist Open (PPO) plan feature primary care physician visits with no copay and no coinsurance, while specialist visits, therapy services, and mental health sessions require a $25 copay and no coinsurance. Telehealth services are covered with a copay ranging from $0 to $35 and no coinsurance, but podiatry is not covered, and only some chiropractic services are covered as routine and other chiropractic services are excluded.
Preventive Services See details
Wellcare Assist Open (PPO) preventive services are partially covered, featuring no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes training, fitness benefits, and alternative therapies, while kidney disease education has no copay and 20% coinsurance. Non-covered sub-services include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, nutritional or dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home or bathroom safety, and counseling.
Hearing Services See details
Wellcare Assist Open (PPO) hearing services are partially covered, featuring a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered with no copay or coinsurance up to $1,000 per ear annually, but OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Assist Open (PPO) offers partially covered vision services, featuring one annual routine eye exam with no copay and no coinsurance, though other eye exam services are not covered. Covered eyewear—including contacts, eyeglasses, lenses, frames, and upgrades—has no copay or coinsurance, up to a combined maximum benefit of $400 per year.
Dental Services See details
Dental services are partially covered by Wellcare Assist Open (PPO), featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for most preventive and comprehensive services. Prior authorization is required for covered benefits, and orthodontics as well as maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Wellcare Assist Open (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Assist Open (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist Open (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay from specified manufacturers, while diabetic therapeutic shoes or inserts carry a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Wellcare Assist Open (PPO), with prior authorization required for these services. Outpatient diagnostic tests and procedures feature no coinsurance and copays ranging from no copay to $25, lab services have no copay, outpatient X-rays require a $25 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Wellcare Assist Open (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Assist Open (PPO) with no coinsurance, though some services are covered while standard cardiac ($40 copay), intensive cardiac ($50 copay), pulmonary ($35 copay), and SET for PAD ($25 copay) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Assist Open (PPO) with no coinsurance, featuring no copay for days 1 through 20 and days 51 through 100, and a $218 daily copay for days 21 through 50. Prior authorization is required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Wellcare Assist Open (PPO) partially covers other services, offering over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered under this plan, and a referral is required to receive the meal benefits.
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