A non-government entity
Wellcare Mutual of Omaha Simple Open (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Mutual of Omaha 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 Mutual of Omaha Simple Open (PPO) in 2025, please refer to our full plan details page.
Wellcare Mutual of Omaha Simple Open (PPO) is a PPO plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in MO. The overall rating for this plan is not yet available for 2025.
It's important to know that Wellcare Mutual of Omaha 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 Mutual of Omaha 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 Mutual of Omaha 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 $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 $6200.00 (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 $6200.00 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 Open (PPO) plan has a $420 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies or preferred mail order, and a $10 copay at standard pharmacies and standard mail order. For other tiers, you will pay coinsurance ranging from 25% to 50%. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellcare Mutual of Omaha Simple Open (PPO) plan offers a range of benefits. Inpatient hospital stays have a copay, and outpatient services vary in cost, including blood services with no copay. The plan includes coverage for primary care with no copay, preventive services with no copay, and vision and dental services with various copays. Hearing services are covered with copays, and prescription hearing aids are covered up to $1,000 per ear annually.
Inpatient Hospital See details
Inpatient Hospital coverage includes a copay of $350 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $325 for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric; Additional Days, Non-Medicare-covered Stay, and Upgrades are not covered for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay are not covered for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $325, observation services with a copay between $140 and $325, ambulatory surgical center services with a $150 copay, outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services with no copay. Outpatient blood services include an enhanced benefit: three (3) pint deductible waived.
Partial Hospitalization See details
Partial hospitalization is covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan, but requires prior authorization. You will have a $130 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan, with a $300 copay for both ground and air ambulance services and 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 Open (PPO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $25 copay; both have no coinsurance. Worldwide Emergency Transportation is not covered, and the plan has a maximum benefit coverage of $50,000 for Worldwide Emergency Services.
Primary Care See details
The Wellcare Mutual of Omaha Simple Open (PPO) plan covers primary care physician services with no copay, chiropractic services with a $10 copay, occupational therapy services with a $10 copay, physician specialist services with a $10 copay, mental health specialty services with a $25 copay, podiatry services with a $10 copay, other health care professional services with a copay between $0 and $10, psychiatric services with a $25 copay, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with a $10 copay. Routine chiropractic care is limited to 12 visits per year.
Preventive Services See details
Preventive services, including annual physical exams, are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan with no copay. Kidney disease education services are covered with 20% coinsurance. Additional preventive services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit all have no copay.
Hearing Services See details
The Wellcare Mutual of Omaha Simple Open (PPO) plan covers hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1,000 per ear annually, but 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-$10, and eyewear with no copay. Eyewear includes contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $300 every year.
Dental Services See details
The Wellcare Mutual of Omaha Simple Open (PPO) plan covers Medicare dental services with a $10 copay, as well as oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, but does not cover maxillofacial prosthetics, implant services, or orthodontics. Orthodontic services have a maximum benefit of $3000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Mutual of Omaha Simple Open (PPO) plan. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include 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.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $325, and Outpatient X-Ray Services have a copay of $75. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but 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 services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Mutual of Omaha Simple Open (PPO) plan, but require prior authorization. For days 1-20, there is no copay; for days 21-45, the copay is $214, and for days 46-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits. Over-the-Counter (OTC) Items have no copay, and a maximum benefit coverage amount of $132 every three months; Meal Benefits also have no copay and require a doctor 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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