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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 Select counties in TX. 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 $18.30. 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 $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 $500 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay a $19 copay at a preferred pharmacy, and a $20 copay at a standard pharmacy. The plan has a $0 copay for drugs in the specialty tier.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) plan offers a range of benefits. This plan covers inpatient hospital stays with a high copay, and many outpatient services with a 20% coinsurance. Emergency services have a copay, and primary care services have a 20% coinsurance, while preventive services are covered with no copay. The plan provides additional coverage, including hearing and vision services, and dental services. It also covers home infusion, dialysis, medical equipment, and home health services, each with specific cost-sharing arrangements. There is also coverage for OTC items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered, each with a copay of $2100 and $2036 per admission or stay, respectively. Additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric inpatient hospital services are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a 20% coinsurance and no copay, while observation services have a 20% coinsurance. Outpatient blood services have a 20% coinsurance, with three pints of blood deductible waived. Individual and group sessions for outpatient substance abuse have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by 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 by the Wellcare Dual Access Open (PPO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Wellcare Dual Access Open (PPO D-SNP) plan with a $110 copay and no coinsurance. Urgently Needed Services have a $45 copay and no coinsurance, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $110 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services, all with a 20% coinsurance. Routine Chiropractic Care is not covered, and podiatry services are not covered. Additional Telehealth Benefits also have a copay between $0-$45.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services, including fitness benefits and alternative therapies, with no copay. Kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with a 20% coinsurance. Other services such as health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers hearing exams with a coinsurance of at most 20% and a copay for Medicare-covered benefits and fitting/evaluation for hearing aids with no copay, limited to one visit per year. Prescription hearing aids are covered with a maximum benefit of $500 per ear annually with no copay for all types, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance. Routine eye exams have no copay, while contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades have no copay. This plan offers a combined maximum benefit of $200 per year for eyewear.
Dental Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers Medicare Dental Services with 20% coinsurance and other dental services. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery, all with no copay. Orthodontic services have a maximum benefit of $2000 per year. Prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Dual Access Open (PPO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Dual Access Open (PPO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and requires authorization. Prosthetic devices and Medicare-covered medical supplies have a 20% coinsurance, and authorization is required. Diabetic equipment includes a 20% coinsurance for diabetic supplies and diabetic therapeutic shoes/inserts, and also requires authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests, lab services, and radiological services. Diagnostic procedures/tests and radiological services have a coinsurance of at most 20%, while lab services have a coinsurance of at most 20% and no copay.
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. 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 Dual Access Open (PPO D-SNP) 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 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. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Dual Access Open (PPO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits. The plan offers OTC items with no copay. Meal Benefits are covered with no copay, but require a doctor's 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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