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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 Select counties in MO. This plan received an overall rating of 3 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:
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Drug Coverage
The Wellcare Simple Open (PPO) prescription drug plan features an annual drug deductible of $615. You can maximize your savings with no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when filled at a preferred pharmacy or through preferred mail order. Additionally, Tier 6 (Select Care Drugs) are highly accessible and require no copay across all standard and preferred pharmacy or mail-order options. For brand-name and specialty medications, your costs will be based on a percentage of the drug cost rather than flat copays. Tier 3 (Preferred Brand) and Tier 5 (Specialty Tier) drugs require a 25% coinsurance, while Tier 4 (Non-Preferred Drug) options carry a 35% to 36% coinsurance. If you utilize standard pharmacies or standard mail-order services for generic medications, you will pay copays ranging from $5 to $30 depending on the drug tier and supply duration.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers robust coverage with many essential healthcare services requiring no copayments and no coinsurance. You will pay no copay for primary care visits, routine physicals, and home health care, while specialist visits require a low $10 copay. For hospital stays, inpatient care features no coinsurance and a daily copay for the first six days, followed by no copay for subsequent days. Ancillary benefits include dental care with no copay for preventive and comprehensive services up to a $3,000 annual limit, and vision care with no copay or coinsurance for routine exams and eyewear up to $300 yearly. Additionally, prescription hearing aids are covered with no copay up to a $1,000 annual maximum per ear. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Simple Open (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for acute and psychiatric stays. For acute hospital stays, there is a $350 daily copay for days 1-6 and no copay for days 7-95, though upgrades and non-Medicare-covered stays are not covered. Psychiatric stays require a $325 daily copay for days 1-6 and no copay for days 7-90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Simple Open (PPO) covers outpatient services with no coinsurance, featuring a $0 to $500 copay for outpatient hospital services and a $130 to $500 copay per stay for observation services. Ambulatory surgical center services require a $300 copay and no coinsurance, outpatient substance abuse sessions have a $25 copay and no coinsurance, and outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Wellcare Simple Open (PPO) covers partial hospitalization with a $140.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Simple Open (PPO) covers Medicare-approved ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Wellcare Simple Open (PPO) with a $130 copay and no coinsurance, while urgently needed services require a $25 copay and no coinsurance. Worldwide emergency and urgent services 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) covers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits have a $10 copay and no coinsurance. Mental health and psychiatric services require a $25 copay and no coinsurance, though podiatry and non-routine chiropractic services are not covered.
Preventive Services See details
Wellcare Simple Open (PPO) partially covers preventive services, offering an annual physical exam, fitness benefits, alternative therapies, and select screenings with no copay and no coinsurance, while kidney disease education requires no copay and a 20% coinsurance. Several supplemental sub-services are not covered, including health education, weight management, nutritional/dietary benefits, in-home support, and counseling.
Hearing Services See details
Wellcare Simple Open (PPO) provides partially covered hearing services, including Medicare-covered exams for a $10 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Covered prescription hearing aids have no copay and no coinsurance up to a $1,000 annual maximum per ear, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Simple Open (PPO), offering one routine eye exam per year and eyewear with no deductible, no copays, and no coinsurance. A combined maximum benefit of $300 per year applies to eyewear, while other eye exam services are not covered.
Dental Services See details
Wellcare Simple Open (PPO) covers Medicare dental services with a $10 copay and no coinsurance, and partially covers other preventive and comprehensive dental services with no copay and no coinsurance up to a $3,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Simple Open (PPO) with no copay and no coinsurance, though prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Simple Open (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Simple Open (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay, while diabetic therapeutic shoes and inserts are subject to a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Simple Open (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and lab services feature no coinsurance, with lab services requiring no copay and other diagnostic tests carrying a copay of $0 to $50. Diagnostic radiological services have a $0 minimum copay, outpatient X-rays require a $50 copay, and therapeutic radiological services have a 20% coinsurance.
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
Cardiac Rehabilitation Services are not covered under the Wellcare Simple Open (PPO) plan, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are all not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Simple Open (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 51 to 100, while days 21 to 50 require a $218 daily copay; additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Wellcare Simple Open (PPO) plan, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered, and a referral is required to access the meal benefit.
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