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Wellcare Complete Simple Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Complete 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 Complete Simple Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Complete Simple Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in Kansas. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Complete 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 Complete 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 Complete 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 $5450.00 (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 $5450.00 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 Complete Simple Open (PPO)
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Drug Coverage
The Wellcare Complete Simple Open (PPO) plan has a $420 deductible for prescription drugs. Once you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, but a $10 copay at standard pharmacies. For specialty tier drugs, you will have no copay regardless of the pharmacy.
Additional Benefits
The Wellcare Complete Simple Open (PPO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including blood services, have no copay. Emergency and urgent care services have a copay, and primary care visits are also covered with no copay. Preventive services, hearing exams, vision services, and many dental services have no copay, while more advanced services like restorative dental work have a coinsurance. The plan also covers home health services, and many diagnostic and radiological services with no copay, as well as offering an over-the-counter benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $400 copay for days 1-5, and no copay for days 6-90. Additional days, non-Medicare covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Wellcare Complete Simple Open (PPO) plan. Outpatient hospital services have a copay between $0 and $280, observation services have a copay between $140 and $280, and ambulatory surgical center (ASC) services have a $200 copay. Outpatient substance abuse services have a $35 copay for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Complete 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 by the Wellcare Complete Simple Open (PPO) plan. Medicare-covered ground and air ambulance services have a $250 copay, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $140, $35, and $140 respectively, with no coinsurance. Worldwide Urgent Coverage also has a $140 copay with no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Complete Simple Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $25 copay. This plan also covers physician specialist services and physical therapy/speech-language pathology services with a $25 copay, and telehealth services with a copay ranging from $0 to $35. Mental health and psychiatric services have a $35 copay for individual and group sessions, while podiatry services and opioid treatment program services also require a copay of $25.
Preventive Services See details
The Wellcare Complete Simple Open (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including services like Glaucoma Screening and Diabetes Self-Management Training, are covered with no copay, while other services like Health Education, In-Home Safety Assessment, and others are not covered. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum plan benefit of $1500 per year, and Prescription Hearing Aids (all types) have no copay, however, Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Wellcare Complete Simple Open (PPO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $25, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and have a combined maximum benefit of $200 per year.
Dental Services See details
The Wellcare Complete Simple Open (PPO) plan covers Medicare dental services with a $25 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventative dental services are covered with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 40% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services are covered with a maximum benefit of $3,000 per year.
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 by the Wellcare Complete Simple Open (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, and lab services, are covered with no copay for diagnostic procedures/tests and lab services. Radiological services are covered with a copay of at most $280.00 for diagnostic radiological services and a 20% coinsurance for therapeutic radiological services; outpatient X-Ray services have a $25.00 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Complete Simple Open (PPO) plan with no copay and no coinsurance, however, 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 Complete Simple Open (PPO) plan. Although the plan covers some Cardiac Rehabilitation Services, it 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 under the Wellcare Complete Simple Open (PPO) plan, but require prior authorization. For days 1-20 and 41-100, there is no copay, and for days 21-40, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits. Over-the-Counter (OTC) Items have no copay and a maximum plan benefit coverage amount of $161 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone coverage, while a doctor's referral is required for Meal Benefits, which also has no copay. Acupuncture, 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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