A non-government entity
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 Select counties in IL. 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 $5750.00 (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 $5750.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple Open (PPO) plan has a $420.00 deductible for prescription drugs. After meeting the deductible, you'll pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you'll pay no copay for preferred generic drugs at preferred pharmacies or preferred mail order. Standard generic drugs have a 25% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a $400 copay for the first six days, and no copay for days 7-90. The plan also covers a wide range of outpatient services, primary care, and preventive services, often with no copays or low copays. Additional benefits include hearing, vision, and dental services, along with coverage for home health, skilled nursing, and durable medical equipment.
Inpatient Hospital See details
Inpatient hospital services are covered, with a copay of $400 for days 1-6, and no copay for days 7-90. Additional days, non-Medicare-covered stays, and upgrades for inpatient hospital are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $300, observation services with a copay between $140 and $300, ambulatory surgical center services with a $250 copay, individual and group sessions for outpatient substance abuse with a $40 copay, and outpatient blood services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple Open (PPO) plan, but requires prior authorization. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ambulance services require a copay of $280 for both ground and air ambulance services, with no coinsurance. Transportation services to a plan-approved health-related location are covered with no copay and no coinsurance for up to 24 one-way trips per year, but transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $140, while Urgently Needed Services has no copay. Worldwide Urgent Coverage also has a copay of $140, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Open (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $30 copay, while physician specialist services have a $30 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Other health care professional services and opioid treatment program services have a minimum copay of $0 and $30 respectively, and a maximum copay of $30. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services with varying copays. Kidney Disease Education Services have a 20% coinsurance, while Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The Wellcare Simple Open (PPO) plan covers hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $750 per ear every year, and prescription hearing aids (all types) have no copay.
Vision Services See details
The Wellcare Simple Open (PPO) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with no copay, with a combined maximum plan benefit of $300 per year for both in-network and out-of-network services. Routine eye exams are covered with no copay, but are limited to 1 per year.
Dental Services See details
Dental Services are covered, including oral exams with no copay, and other dental services with a $30 copay for Medicare dental services. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with 40% coinsurance. Orthodontic Services are covered up to a $3,000 maximum per year, while Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. 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 Simple Open (PPO) plan. The coinsurance for these services is between 20% and 20%.
Medical Equipment See details
The Wellcare Simple Open (PPO) plan covers Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetic Devices and Medical Supplies with 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellcare Simple Open (PPO) plan. All diagnostic procedures and tests have a copay between $0 and $75, and lab services have no copay. Diagnostic radiological services have a copay of up to $300, therapeutic radiological services have 20% coinsurance, and outpatient X-ray services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple Open (PPO) plan with a 20% coinsurance, and there is no copay. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellcare Simple Open (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Open (PPO) plan. For days 1-20, there is no copay; for days 21-40, the copay is $214; and for days 41-100, there is no copay.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $95 every three months. Acupuncture, meal benefits, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved