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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 2025, 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 Select Counties in South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $22.90. 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 $590.00 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 $8950.00 (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 $8950.00 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 has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you pay a $19 or $20 copay, while standard generic drugs have a 20% coinsurance. Preferred brand drugs have a $100 copay, and non-preferred drugs have a 25% coinsurance. Specialty tier drugs have no copay.
Additional Benefits
The Wellcare Assist Open (PPO) plan offers a variety of benefits beyond standard Medicare coverage. This plan includes no copay for primary care, preventive services, home health, and vision eyewear, as well as no copay for outpatient blood services and OTC items. It also provides coverage for emergency services, hearing aids, dental, and other services, with varying copays or coinsurance amounts depending on the specific service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, there is a $350 copay for days 1-4, and no copay for days 5-90, and for Inpatient Hospital Psychiatric, there is a $374 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute has no copay for days 91-120. Non-Medicare-covered stays and upgrades for both 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 $280, Observation Services with a copay between $125 and $280, Ambulatory Surgical Center (ASC) Services with a $250 copay, Outpatient Substance Abuse Services with a $25 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Assist Open (PPO) plan. This benefit requires prior authorization and has a copay of $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including services not usually covered by Medicare, are covered by the Wellcare Assist Open (PPO) plan. Ground and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location have no copay and include 12 one-way trips per year via rideshare, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered under the Wellcare Assist Open (PPO) plan, with a $125 copay, and no coinsurance. Urgently needed services have a $40 copay, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Assist Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $25 copay, physician specialist services with a $15 copay, mental health specialty services with a $25 copay, podiatry services with a $15 copay, and other health care professional services with a copay between $0 and $15. This plan also covers psychiatric services with a $25 copay, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $15 copay. Routine chiropractic care is not covered.
Preventive Services See details
The Wellcare Assist Open (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, remote access technologies, and alternative therapies, are covered with a $0 copay. Kidney disease education services have a 20% coinsurance. Other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay.
Hearing Services See details
Hearing services include hearing exams with a $15 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids, with a maximum plan benefit of $350 per ear per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$15, and eyewear with no copay. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay. This plan has a combined maximum of $300 per year for eyewear, applicable to both in-network and out-of-network services.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $15 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, but do not cover maxillofacial prosthetics, implant services, and orthodontics. Orthodontic Services have a maximum plan benefit coverage of $4,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Assist Open (PPO) plan, and prior authorization is required. 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 Assist Open (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while other medical supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of at most $275, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Assist Open (PPO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The copay information is available below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Assist Open (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, while days 21-60 have a $214 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefit coverage, with no copay for either benefit. Acupuncture and several other services are not covered. The OTC benefit has a maximum coverage amount of $120 every three months.
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