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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. After the deductible is met, the plan covers drugs with varying costs depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at preferred and mail-order pharmacies, while standard generic drugs have 25% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Mutual of Omaha Simple Secure Open (PPO) plan offers a wide range of benefits with varying cost-sharing. Hospital stays have copays, while outpatient services can have copays ranging from no cost to $250. Primary care, preventive services, and vision services, including eye exams and eyewear, often have no copay, while dental services, hearing exams, and some outpatient services also have no copay. The plan provides coverage for emergency services with a $125 copay and ambulance services with a $300 copay. Additionally, you'll find benefits for home health, medical equipment, and home infusion with specific cost-sharing arrangements. Other benefits include OTC items, dialysis services, and skilled nursing facilities, all with their own respective copays and coinsurance.
Inpatient Hospital See details
The Wellcare Mutual of Omaha Simple Secure Open (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $320 copay for days 1-5 and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $225 copay for days 1-5 and no copay for days 6-90. Additional days and non-Medicare covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay of $0-$250, observation services with a copay of $125-$250, ambulatory surgical center services with a $150 copay, and outpatient substance abuse services with a $25 copay for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Mutual of Omaha Simple Secure Open (PPO) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Mutual of Omaha Simple Secure Open (PPO) plan. Ground and air ambulance services each have a $300 copay, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered by the Wellcare Mutual of Omaha Simple Secure Open (PPO) plan, with a copay of $125.00, but Worldwide Emergency Transportation is not covered. Urgently Needed Services have a $30 copay.
Primary Care See details
The Wellcare Mutual of Omaha Simple Secure Open (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, 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. Primary care physician services, chiropractic services, physician specialist services, and physical therapy have no copay. Mental health specialty services and psychiatric services for individual and group sessions have a $25 copay. Other health care professional services, additional telehealth benefits, and opioid treatment program services have a copay between $0 and $30. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Wellcare Mutual of Omaha Simple Secure Open (PPO) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services with a copay. Kidney disease education services have a 20% coinsurance, and other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, have no copay. Some services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay, and routine hearing exams and fitting/evaluation for hearing aids also have no copay; prescription hearing aids have a maximum benefit of $350 per year. OTC hearing aids, and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. There is no copay for eye exams, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage amount of $100 per year.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and adjunctive general services with no copay. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and 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 with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including 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 include coverage for all diagnostic services with a copay between $0 and $10, lab services with no copay, diagnostic radiological services with a copay of at most $250, therapeutic radiological services with coinsurance of at least 20%, and outpatient X-ray services with a $75 copay. All services require prior authorization.
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 technically covered, but not covered in practice, as 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 are not covered. There is a copay for some services, but no other cost sharing information is provided.
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. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Wellcare Mutual of Omaha Simple Secure Open (PPO) plan covers over-the-counter (OTC) items with no copay and a maximum benefit of $30 every three months, and meal benefits with no copay and a doctor referral. Acupuncture, 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, 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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