A non-government entity
Wellcare Mutual of Omaha Simple Secure Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Mutual of Omaha Simple Secure Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Mutual of Omaha Simple Secure Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Mutual of Omaha Simple Secure Open (PPO) is a PPO 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 Mutual of Omaha Simple Secure 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 Mutual of Omaha Simple Secure 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 Mutual of Omaha Simple Secure 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 $9000.00 (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 $9000.00 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 Mutual of Omaha Simple Secure Open (PPO) plan has a $420 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. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, but a $10 copay at standard pharmacies and standard mail order. Specialty tier drugs have no copay at any pharmacy.
Additional Benefits
The Wellcare Mutual of Omaha Simple Secure Open (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Emergency, primary care, and preventive services often have no copay. The plan covers hearing, vision, and dental services, with some services having no copay. Additionally, the plan covers home health services with no copay, and skilled nursing facility (SNF) services with a copay for certain days. The plan also includes coverage for ambulance, diagnostic, and dialysis services with copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes a copay of $305 for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $225 for days 1-5, and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a copay between $125 and $350, Ambulatory Surgical Center (ASC) Services with a $150 copay, and Outpatient Substance Abuse Services with a $25 copay for both individual and group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Mutual of Omaha Simple Secure Open (PPO) plan, with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $290 copay for both ground and air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Coverage, are covered under the Wellcare Mutual of Omaha Simple Secure Open (PPO) plan. Emergency Services have a $125 copay and no coinsurance, Urgent Services have a $30 copay and no coinsurance, and Worldwide Emergency Coverage has a $125 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Mutual of Omaha Simple Secure Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $5 copay, occupational therapy services with a $5 copay, physician specialist services with a $5 copay, and mental health specialty services with a $25 copay for individual and group sessions. The plan also covers other health care professional services with a copay between $0 and $5, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $5 copay, additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a $5 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services including fitness, remote access technologies, and alternative therapies. Kidney disease education services have a 20% coinsurance, while glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit have no copay. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, 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, or counseling services.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered under the Wellcare Mutual of Omaha Simple Secure Open (PPO) plan. Hearing exams have a $5 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, with a maximum benefit of $350 per year, and prescription hearing aids (all types) have no copay; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Wellcare Mutual of Omaha Simple Secure Open (PPO) plan covers vision services, including eye exams with a copay between $0 and $5, and eyewear with no copay. Eyewear has a combined maximum benefit of $100 per year for both in-network and out-of-network services.
Dental Services See details
The Wellcare Mutual of Omaha Simple Secure Open (PPO) plan covers dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, and adjunctive general services with no copay; however, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Medicare Dental Services have a $5 copay.
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 Mutual of Omaha Simple Secure Open (PPO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment coverage includes 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. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $10, and lab services with no copay. Radiological services are covered with a copay of up to $250 for diagnostic services, 20% coinsurance for therapeutic services, and a $75 copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Wellcare Mutual of Omaha Simple Secure Open (PPO) 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 Mutual of Omaha Simple Secure Open (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Mutual of Omaha Simple Secure Open (PPO) plan, but require prior authorization. You will have no copay for days 1-20 and 61-100, but will have a $214 copay for days 21-60. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Wellcare Mutual of Omaha Simple Secure Open (PPO) plan's other services benefit covers over-the-counter (OTC) items and meal benefits. OTC items have no copay, while meal benefits also have no copay and 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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