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Wellcare Assist Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist Open (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist Open (PPO) in 2026, please refer to our full plan details page.
Wellcare Assist 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 Assist 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 Assist 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 Assist Open (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.00. 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:
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Drug Coverage
The Wellcare Assist Open (PPO) plan features an annual prescription drug deductible of $615. For Tier 6 select care drugs, you will benefit from no copay for all supply durations at both standard and preferred pharmacies. Tier 1 preferred generic and Tier 2 generic drugs offer low copays starting at $18 and $19 respectively, with no copay required for three-month supplies filled through preferred mail order. For brand-name and specialty medications, the plan utilizes coinsurance and set copayments. Tier 3 preferred brand drugs carry a 21% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. Tier 4 non-preferred drugs have a flat copay starting at $100 for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Wellcare Assist Open (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs and no coinsurance for many primary services. You will pay no copay for primary care visits, while specialist visits require a low $15 copay. For hospital stays, inpatient acute care has a $400 copay for the first six days followed by no copay, and emergency room visits feature a $130 copay that is waived if you are admitted. In addition to core medical care, this plan provides valuable everyday benefits like dental, vision, and hearing coverage with no copay for routine annual exams. You can take advantage of up to $4,000 in annual dental services and a $300 yearly allowance for eyewear with no copay or coinsurance. The plan also includes no-copay transportation for up to 12 one-way trips per year and no-copay over-the-counter items to help manage your health.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Wellcare Assist Open (PPO) with no coinsurance, as upgrades and non-Medicare-covered stays are not covered. Covered acute stays require a $400 copay for days 1 through 6 and no copay for days 7 through 95, while psychiatric stays require a $374 copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Wellcare Assist Open (PPO) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $280 for outpatient hospital services and $130 to $280 per stay for observation services. Ambulatory surgical center visits require a $250 copay and no coinsurance, outpatient substance abuse sessions have a $25 copay and no coinsurance, and outpatient blood services are provided with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Assist Open (PPO) plan with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Wellcare Assist Open (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under Wellcare Assist Open (PPO) are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services require a $40 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, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist Open (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Physical, occupational, mental health, and psychiatric therapies require a $25 copay and no coinsurance, while podiatry is not covered and chiropractic services are only partially covered with routine and other chiropractic services excluded.
Preventive Services See details
Wellcare Assist Open (PPO) covers annual physical exams, fitness benefits, remote access, alternative therapies, and select screenings with no copay and no coinsurance, while kidney disease education is covered with no copay and 20% coinsurance. However, preventive services are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety modifications, and counseling services.
Hearing Services See details
Wellcare Assist Open (PPO) covers hearing services with no coinsurance, featuring a $15 copay for Medicare-covered exams and no copay for annual routine exams and fittings. Prescription hearing aids are partially covered with no copay up to $350 per ear annually, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services under the Wellcare Assist Open (PPO) are partially covered with no deductible, offering no copay and no coinsurance for an annual routine eye exam and eyewear up to a $300 yearly limit. Prior authorization is required for covered benefits, and other eye exam services are not covered.
Dental Services See details
Wellcare Assist Open (PPO) provides partially covered dental services, featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and most comprehensive dental services up to a $4,000 yearly maximum. While many restorative, endodontic, and periodontic services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Assist Open (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellcare Assist Open (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist Open (PPO) covers durable medical equipment (DME), prosthetics, and medical supplies with no copayment and a 20% coinsurance. Diabetic supplies are covered with no copayment, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Assist Open (PPO) covers diagnostic and radiological services with prior authorization. Diagnostic tests and procedures have a $0 to $50 copay and no coinsurance, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Wellcare Assist Open (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Assist Open (PPO) covers cardiac rehabilitation services with no coinsurance, though some services are not covered, including standard cardiac rehabilitation with a $40 copay, intensive cardiac rehabilitation with a $50 copay, pulmonary rehabilitation with a $35 copay, and supervised exercise therapy for peripheral artery disease with a $25 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Assist Open (PPO) with no coinsurance and do not require a prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20 and days 51 through 100, while days 21 through 50 require a $218 daily copay, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Assist Open (PPO) offers partial coverage for other services, providing over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under these services, and the meal benefit requires a referral.
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