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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 2025, 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 AZ. This plan received an overall rating of 2.5 out of 5 stars in 2025.
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 $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 $9000.00 (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 $9000.00 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:
Sign up for Wellcare Simple Open (PPO)
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Drug Coverage
The Wellcare Simple Open (PPO) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay the following costs for drugs in each tier. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. For standard generic drugs, you will pay 25% coinsurance. For preferred brand drugs, you will pay 44% coinsurance at preferred pharmacies and mail order, and 45% coinsurance at standard pharmacies. For non-preferred drugs, you will pay 28% coinsurance. For specialty tier drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services have copays that range from $0 to $350. Emergency, primary care, preventive, and home health services often have no copay. The plan also covers hearing, vision, and dental services. Hearing exams and hearing aid fittings have no copay, while prescription hearing aids are covered up to $750 per ear. Vision benefits include eye exams with a copay and eyewear with a $200 annual allowance. Dental services have a $30 copay for Medicare services, while restorative services have 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Wellcare Simple Open (PPO) plan. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a copay between $125 and $350, 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. All services may require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple Open (PPO) plan, with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple Open (PPO) plan. Ground and air ambulance services have a $250 copay, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $40 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Open (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while routine chiropractic care has a $20 copay for up to 12 visits per year. Occupational therapy services have a $45 copay, and physician specialist services have a $30 copay. Mental health and psychiatric services have a $25 copay for individual or group sessions, and podiatry services have a $30 copay. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a copay between $0 and $45. Opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, an annual physical exam with no copay, and additional preventive services with a copay for Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Alternative Therapies. Kidney Disease Education Services are covered with 20% coinsurance, and other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Wellcare Simple Open (PPO) offers hearing services, including hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $750 per ear, with no copay for all types, but prescription hearing aids - 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 and eyewear. Eye exams have a copay of $0-$30, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have a combined maximum plan benefit of $200 per year, and have no copay.
Dental Services See details
Dental Services are covered, 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. You will pay a $30 copay for Medicare dental services, and 20% coinsurance for restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Orthodontic services have a $2,000 maximum plan benefit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Wellcare Simple Open (PPO) plan, but 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 under the Wellcare Simple 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, Prosthetic Devices and Medical Supplies have a 20% coinsurance, Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Simple Open (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $350, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $76 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Simple Open (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Wellcare Simple Open (PPO) plan, but the plan does not cover any specific services. The plan mentions that there is a copay, but does not specify the amount.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Open (PPO) plan, but require prior authorization. For days 1-20, there is no copay, days 21-50 have a $200 copay, and days 51-100 have no copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $48.00 every three months, but Acupuncture, Meal Benefit, 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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