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Wellcare Dual Access Sync Open (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Dual Access Sync 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 Sync Open (PPO D-SNP) in 2026, please refer to our full plan details page.
Wellcare Dual Access Sync 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 Kansas. This plan received an overall rating of 2.5 out of 5 stars in 2026.
It's important to know that Wellcare Dual Access Sync 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 Sync 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 Sync 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 Sync Open (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.40. 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 $550.00 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 Sync Open (PPO D-SNP) prescription drug plan features an annual drug deductible of $550. Tier 1 preferred generics start at an $18 copay for a one-month supply at preferred pharmacies, while Tier 2 generics start at a $19 copay. Notably, Tier 6 select care drugs feature no copay, and you can also receive a three-month supply of Tier 1 and Tier 2 drugs with no copay through preferred mail order. For higher-tier medications, Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance. Tier 4 non-preferred drugs carry a $100 copay for a one-month supply at both standard and preferred pharmacies. Utilizing preferred pharmacies and preferred mail-order services helps maximize your savings on this plan.
Additional Benefits
The Wellcare Dual Access Sync Open (PPO D-SNP) offers comprehensive medical coverage, featuring no copay and a 20% coinsurance for primary care, specialist visits, outpatient hospital services, and diagnostic tests. For inpatient hospital stays, members pay a $2,075 copay per stay with no coinsurance, while emergency room visits require a $115 copay. Skilled nursing facility care has no coinsurance, featuring no copay for days 1 to 20 and 71 to 100, though a $218 daily copay applies for days 21 to 70. This plan also provides valuable supplemental benefits, including preventive services, home health, and over-the-counter items with no copay and no coinsurance. Dental care is covered up to a $3,000 yearly limit with no copay and no coinsurance for select services, while routine hearing and vision exams require no copay and a 20% coinsurance. Additionally, members can access up to 12 one-way transportation trips per year and prescription hearing aids up to $500 per ear annually with no copay or coinsurance.
Inpatient Hospital See details
Wellcare Dual Access Sync Open (PPO D-SNP) partially covers inpatient hospital services, requiring a $2,075 copayment per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers outpatient services with no copay and 20% coinsurance for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, and there is no deductible for outpatient blood.
Partial Hospitalization See details
Partial hospitalization is covered by Wellcare Dual Access Sync Open (PPO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization.
Ambulance and Transportation Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 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 Sync 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 admitted to the hospital within 24 hours. Worldwide emergency and urgent care are 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 Sync Open (PPO D-SNP) covers primary care, specialist visits, mental health, and therapy services with no copay and 20% coinsurance. Additional telehealth benefits are available with a copay of $0.00 to $40.00 and 20% coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under the Wellcare Dual Access Sync Open (PPO D-SNP) are partially covered, offering annual physicals, fitness benefits, personal emergency response systems, alternative therapies, and remote access technologies with no copay and no coinsurance, while kidney education and other screenings require no copay and a 20% coinsurance. Sub-services not covered under this plan include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers routine hearing exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Dual Access Sync Open (PPO D-SNP) with no deductible, as other eye exam services are not covered. One routine eye exam is covered annually with no copay and 20% coinsurance, while covered eyewear has no copay and up to a $400 yearly limit, requiring 20% coinsurance for contact lenses and no coinsurance for eyeglasses.
Dental Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) provides partially covered dental services, featuring Medicare-covered dental care with no copay and 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $3,000 yearly limit. 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 Dual Access Sync Open (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required. Associated Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Dual Access Sync Open (PPO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, though prior authorization is required. Covered benefits include Medicare-approved diagnostic procedures, lab tests, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Wellcare Dual Access Sync Open (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay under the Wellcare Dual Access Sync Open (PPO D-SNP), but only some services are covered since standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Wellcare Dual Access Sync Open (PPO D-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is needed. There is no copay for days 1 to 20 and days 71 to 100, but a $218 daily copay applies for days 21 to 70; additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Wellcare Dual Access Sync Open (PPO D-SNP) partially covers other services, which include over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and other additional services under this category are not covered, and a referral is required to access the meal benefit.
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