A non-government entity
Wellcare Simple Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare 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 Simple Open (PPO) in 2026, please refer to our full plan details page.
Wellcare Simple Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Statewide in SC. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Wellcare 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 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 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 $615.00 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 $10100.00 (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 $10100.00 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 Simple Open (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellcare Simple Open (PPO) plan features an annual prescription drug deductible of $615. Under this plan, you will benefit from no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when using a preferred pharmacy or preferred mail-order service. Additionally, Tier 6 (Select Care Drugs) are covered with no copay at both standard and preferred pharmacies. For brand-name and specialty medications, your costs are determined by a coinsurance percentage. Tier 3 (Preferred Brand) and Tier 5 (Specialty) drugs require a 25% coinsurance, while Tier 4 (Non-Preferred) drugs carry a 35% to 36% coinsurance depending on whether you use a preferred or standard pharmacy. Standard pharmacies also require copays ranging from $5 to $30 for Tier 1 and Tier 2 generic drugs.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers robust medical coverage featuring no copays and no coinsurance for primary care visits, annual physical exams, and home health services. Specialist visits and rehabilitation therapies require a low $20 copay with no coinsurance, while emergency room visits carry a $130 copay. For hospital care, inpatient stays require a $350 daily copay for the first six days and no copay for days seven through 95. Supplemental benefits include routine hearing and vision exams with no copay, alongside annual allowances for hearing aids and eyewear. Preventive dental care is available with no copay, while comprehensive dental services require a 20% coinsurance up to a $1,500 yearly limit. Durable medical equipment and dialysis services are also covered with a standard 20% coinsurance and no copays.
Inpatient Hospital See details
Wellcare Simple Open (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 6 of acute care (no copay for days 7 through 95) and a $1,590 copay per psychiatric stay. Prior authorization is required, but hospital upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple Open (PPO) covers outpatient hospital services with no coinsurance and copays ranging from no copay to $450, and ambulatory surgical center services with a $450 copay and no coinsurance. Outpatient substance abuse sessions require a $25 copay and no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Simple Open (PPO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Wellcare Simple Open (PPO) covers Medicare-approved ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. While transportation services are listed as covered, only some services are covered as transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Wellcare Simple Open (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Simple Open (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, occupational therapy, and physical therapy require a $20 copay and no coinsurance. Mental health and psychiatric services feature a $25 copay with no coinsurance, and telehealth benefits are available with a $0 to $30 copay and no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services offered by Wellcare Simple Open (PPO) are partially covered, featuring no copay and no coinsurance for annual physical exams, fitness benefits, alternative therapies, and screenings such as glaucoma and diabetes self-management. Kidney disease education is covered with no copay and a 20% coinsurance, but several supplemental benefits—including health education, personal emergency response systems (PERS), in-home safety assessments, and weight management—are not covered.
Hearing Services See details
Wellcare Simple Open (PPO) covers Medicare-covered hearing exams for a $20 copay and routine exams or fitting evaluations with no copay, with no coinsurance required for these services. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 maximum benefit per ear annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Simple Open (PPO), offering one annual routine eye exam and eyewear with no copay, no coinsurance, and no deductible, while other eye exam services are not covered. Covered eyewear options like contacts, lenses, frames, and upgrades are subject to a combined maximum benefit of $100 per year.
Dental Services See details
Wellcare Simple Open (PPO) offers partially covered dental services, with Medicare-covered dental at a $20 copay and no coinsurance, and preventive services at no copay and no coinsurance. Comprehensive services are covered with no copay and a 20% coinsurance up to a $1,500 yearly limit, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple Open (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Wellcare Simple Open (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple Open (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic supplies, with no copays. A 20% coinsurance applies to DME, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts, and prior authorization is required.
Diagnostic and Radiological Services See details
Wellcare Simple Open (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for lab work, and a $0 to $75 copay for diagnostic procedures. Radiological services include outpatient X-rays for a $50 copay with coinsurance, diagnostic radiology with copays starting as low as no copay, and therapeutic radiology with a minimum 20% coinsurance and a copay.
Home Health Services See details
Wellcare Simple Open (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Simple Open (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though copays apply depending on the specific service. Standard cardiac rehabilitation requires a $40 copay, intensive cardiac rehabilitation is $50, pulmonary rehabilitation is $35, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) is $25.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Wellcare Simple Open (PPO) with no coinsurance, featuring no copay for days 1 to 20 and 51 to 100, and a $218 daily copay for days 21 to 50. Prior authorization is required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Wellcare Simple Open (PPO) indicates that some services are covered under its Other Services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved