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Wellcare Dual Access Open (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access Open (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Dual Access Open (PPO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access Open (PPO D-SNP) is a PPO D-SNP 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 Dual Access Open (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Wellcare Dual Access Open (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Dual Access Open (PPO D-SNP).
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 Dual Access Open (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 $515.00 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 $13900.00 (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 $13900.00 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 Dual Access Open (PPO D-SNP) prescription drug plan features an annual drug deductible of $515. For Tier 1 preferred generics, copays start as low as $18 at preferred pharmacies, while Tier 2 generics start at a $19 copay. Notably, you can receive a three-month supply of both Tier 1 and Tier 2 drugs with no copay when using preferred mail order services. Tier 3 preferred brand drugs require a 20% coinsurance across all pharmacy options. Tier 4 non-preferred drugs have a $100 copay for a one-month supply, while Tier 5 specialty drugs require a 25% coinsurance. Finally, Tier 6 select care drugs are available with no copay for all fulfillment methods.
Additional Benefits
The Wellcare Dual Access Open (PPO D-SNP) offers comprehensive medical coverage, featuring an inpatient hospital stay copay of $1,840 per admission with no coinsurance. Most outpatient services, primary care visits, specialist consultations, and diagnostic tests require no copay and a 20% coinsurance. Emergency care is accessible with a $115 copay, which is waived if you are admitted, while urgent care carries a $40 copay. This plan also provides valuable supplemental benefits, including home health services, routine transportation, and over-the-counter items with no copay and no coinsurance. Additionally, dental services feature no copay or coinsurance for most preventive and comprehensive care up to a $5,000 annual limit, alongside no-copay coverage for prescription hearing aids up to $750 per ear. Skilled nursing facility stays are also covered with no copay for days 1 to 20 and a $218 daily copay for days 21 to 70.
Inpatient Hospital See details
Wellcare Dual Access Open (PPO D-SNP) partially covers inpatient acute and psychiatric hospital stays with a $1,840 copay per admission and no coinsurance. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Wellcare Dual Access Open (PPO D-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for several of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Wellcare Dual Access Open (PPO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Dual Access Open (PPO D-SNP) covers ambulance services with a 20% coinsurance and no copay for both ground and air transport, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Dual Access Open (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 lifetime maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Dual Access Open (PPO D-SNP) covers primary care, specialist, therapy, mental health, and psychiatric services with no copay and a 20% coinsurance. Chiropractic services are partially covered, providing routine care with no copay or coinsurance for up to 12 visits yearly, while other chiropractic services are not covered. Podiatry services are also covered with no copay and no coinsurance for up to 4 routine visits per year.
Preventive Services See details
Wellcare Dual Access Open (PPO D-SNP) offers partially covered preventive services, featuring no copay and no coinsurance for annual physical exams, fitness benefits, and personal emergency response systems. Kidney disease education and other screenings have no copay but require a 20% coinsurance, while services like health education, nutritional benefits, and in-home support are not covered.
Hearing Services See details
Wellcare Dual Access Open (PPO D-SNP) offers partially covered hearing services, including routine hearing exams with no copay and a 20% coinsurance, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to $750 per ear annually, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Wellcare Dual Access Open (PPO D-SNP) offers partially covered vision services, as other eye exam services are not covered. Routine eye exams are covered once per year with no copay and 20% coinsurance, while eyewear benefits are covered up to a $100 annual limit with no copay, except for contact lenses which require a 20% coinsurance.
Dental Services See details
Dental services are partially covered by Wellcare Dual Access Open (PPO D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for most preventive and comprehensive services up to a $5,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Dual Access Open (PPO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Wellcare Dual Access Open (PPO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. This plan ensures you have access to necessary kidney dialysis treatments while clearly outlining your out-of-pocket costs.
Medical Equipment See details
Wellcare Dual Access Open (PPO D-SNP) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Dual Access Open (PPO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, subject to prior authorization. These covered benefits include diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered by Wellcare Dual Access Open (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellcare Dual Access Open (PPO D-SNP) covers Cardiac Rehabilitation Services with no copay, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellcare Dual Access Open (PPO D-SNP) with no coinsurance, featuring no copay for days 1 to 20 and 71 to 100, and a $218 daily copay for days 21 to 70. Prior authorization is required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other services offered by Wellcare Dual Access Open (PPO D-SNP) include over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. The meal benefit requires a referral for eligible chronic or home-confining conditions, and OTC items are available via reimbursement with no maximum coverage limit.
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