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Wellcare Dual Access Open (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access Open (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Dual Access Open (PPO D-SNP) in 2025, please refer to our full plan details page.
Wellcare Dual Access Open (PPO D-SNP) is a PPO D-SNP plan offered by Centene Corporation available for enrollment in 2025 to people living in Statewide in OH. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Wellcare Dual Access Open (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Dual Access Open (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Dual Access Open (PPO D-SNP).
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 Dual Access Open (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.30. 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 $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 $14000.00 (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 $14000.00 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 Dual Access Open (PPO D-SNP) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay a $19 or $20 copay. For standard generic drugs, you will pay 20% coinsurance. Preferred brand drugs have a $100 copay. Non-preferred drugs have 25% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a $1640 copay per admission, while outpatient services and partial hospitalization have a 20% coinsurance. Emergency and urgently needed services have a copay, and transportation services are covered, while many other services are covered with a copay or coinsurance. This plan includes coverage for a wide range of services, including primary care, hearing, vision, dental, and home health services. Many preventive services have no copay, while hearing aids have a maximum annual benefit of $1,000. Dental services include coverage for many services with no copay, and orthodontics are covered up to a $3000 annual maximum.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered under the Wellcare Dual Access Open (PPO D-SNP) plan, with a copay of $1640 per admission or stay for Medicare-covered stays; additional days, non-Medicare-covered stays, and upgrades for both Acute and Psychiatric services are not covered. Prior authorization is required for both.
Outpatient Services See details
Outpatient hospital services, including observation services, are covered, with a 20% coinsurance for both. Individual and group sessions for outpatient substance abuse are covered with a 20% coinsurance. Outpatient blood services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellcare Dual Access Open (PPO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 60 one-way trips per year. 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 Dual Access Open (PPO D-SNP) plan. For Emergency Services, there is a $110 copay and no coinsurance, and for Urgently Needed Services, there is a $45 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Wellcare Dual Access Open (PPO D-SNP) plan. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance; Occupational Therapy Services, Mental Health Specialty Services (individual and group sessions), Psychiatric Services (individual and group sessions), and Opioid Treatment Program Services have a minimum and maximum 20% coinsurance; Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Routine Chiropractic Care is not covered, and Routine Foot Care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services that may have a copay. Kidney disease education, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 20% coinsurance. Fitness Benefit, Personal Emergency Response System (PERS), Remote Access Technologies, and Alternative Therapies are covered with no copay. 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.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay and a maximum of 20% coinsurance, while prescription hearing aids have a maximum benefit of $1,000 per year. 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
Vision Services include eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance. Routine eye exams have no copay, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum plan benefit coverage of $300 every year.
Dental Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers Medicare Dental Services with a 20% coinsurance, and other dental services including oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Orthodontic services are covered up to a $3000 annual maximum. 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. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits are covered by the Wellcare Dual Access Open (PPO D-SNP) plan, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are also covered with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Dual Access Open (PPO D-SNP) 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 not covered by the Wellcare Dual Access Open (PPO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day.
Other Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan's other services include over-the-counter items with no copay, a $100 monthly maximum benefit, and a meal benefit with no copay, but requires a doctor referral. 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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