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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 KS. This plan received an overall rating of 3 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 $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 Simple Open (PPO) plan has a $420 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $10 copay at standard pharmacies. For specialty tier drugs, there is no copay. Other tiers have coinsurance costs that vary by tier and pharmacy.
Additional Benefits
The Wellcare Simple Open (PPO) plan offers coverage for a variety of services with varying costs. Hospital stays have a copay, while outpatient services and home health services may have copays depending on the specific service. The plan also covers preventive services, hearing, vision, and dental services, with some services having no copay and others having copays or coinsurance. Other benefits include coverage for emergency services, primary care, and medical equipment. Additionally, the plan includes coverage for prescription hearing aids up to $500 per ear annually, and covers OTC items with no copay, up to a maximum of $30 every three months. However, some services like certain dental, vision, and hearing services, and other specific medical services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered under the Wellcare Simple Open (PPO) plan. For days 1-7, there is a $350 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services for the Wellcare Simple Open (PPO) plan includes coverage for outpatient hospital services with a copay between $0 and $375, observation services with a copay between $140 and $375, and ambulatory surgical center services with a $245 copay. Outpatient substance abuse services are covered with a $30 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Simple Open (PPO) plan, but requires prior authorization. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Simple Open (PPO) plan, with prior authorization required. Ground and air ambulance services have a copay of $290, 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 under the Wellcare Simple Open (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $50 copay; all three have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Simple Open (PPO) plan covers Primary Care services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy with a $25 copay, Physician Specialist Services with a $25 copay, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. Mental Health Specialty Services and Psychiatric Services have a copay of $30 for individual and group sessions. Additional Telehealth benefits have a copay between $0 and $50, and Opioid Treatment Program Services have a $25 copay. Podiatry Services are not covered.
Preventive Services See details
The Wellcare Simple Open (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including alternative therapies, are covered with no copay. The plan also covers kidney disease education services with 20% coinsurance.
Hearing Services See details
Hearing exams have a $25 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $500 per ear annually, while OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Wellcare Simple Open (PPO) covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, also have no copay, but are limited to a combined maximum of $100 per year.
Dental Services See details
The Wellcare Simple Open (PPO) plan covers dental services, including oral exams and dental x-rays with no copay, and other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment with no copay. Restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery are covered with 40% coinsurance, and orthodontic services are covered up to a $1,000 maximum. Prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Wellcare Simple Open (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellcare Simple Open (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered by the Wellcare Simple Open (PPO) plan, including Durable Medical Equipment with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, with Medicare-covered Diabetic Supplies having no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, lab services, and radiological services. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $75 copay.
Home Health Services See details
Home Health Services are covered under the Wellcare Simple Open (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Wellcare Simple Open (PPO) plan, but no specific services are covered. There is a copay for these services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Simple Open (PPO) plan, with prior authorization required. There is no copay for days 1-20 and days 51-100, but there is a $214 copay for days 21-50.
Other Services See details
Under the Wellcare Simple Open (PPO) plan, acupuncture, meal benefits, 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. Over-the-counter (OTC) items are covered with no copay, up to a maximum of $30 every three months.
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