2027 Medicare Advantage plan

Wellcare Dual Access Sync Open (PPO D-SNP): 2027 benefits and costs

Wellcare PPO D-SNP Special Needs Plan

CMS plan ID: H3975-004-0 · Plan year: 2027

Wellcare Dual Access Sync Open (PPO D-SNP) is a 2027 Medicare Advantage plan offered by Wellcare. It is listed in Kentucky.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$700.00

In-network medical out-of-pocket maximum$9,850.00

Costs shown are before Medicaid or Extra Help; your costs depend on your eligibility and assistance.

Organization: Wellcare
Plan organization: WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC
Parent company: Centene Corporation
Plan type: PPO D-SNP
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
Special Needs Plan type: Dual-Eligible
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

Annual medical deductible: Same as Medicare's Part B deductible
Applies to out-of-network Medicare-covered services and certain in-network Medicare-covered services; out-of-network $0 preventive care is exempt.
In-network medical maximum: $9,850.00
Combined in/out-of-network medical maximum: $14,800.00
Out-of-network medical maximum: Not applicable

Who can join this Special Needs Plan?

This plan is for people who qualify for both Medicare and Medicaid. The plan must confirm the required Medicaid eligibility level. Your costs can depend on your assistance level.

Plan eligibility type: Dual-Eligible

2027 benefit summary

Doctor visits and medical care

Plan-level deductibles may still apply when a service-specific deductible is listed as No.

Common medical services and member costs
Service	In-network	Out-of-network	What to know
Primary care doctor	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No
Specialist visit	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Telehealth	$0.00 to $40.00 copay; 20% coinsurance Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required No
Emergency care	$115.00 copay	Not summarized. Check coverage with the plan.
Urgent care	$40.00 copay	Not summarized. Check coverage with the plan.
Home health	$0.00 copay Service-specific deductible No	$0.00 copay Deductible applies No	Approval required Yes Referral required No
Dialysis	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No	Approval required No Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	0% to 20% coinsurance Deductible applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	0% to 20% coinsurance Deductible applies No	Approval required Yes
Kidney disease education services	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required No Referral required No
Medicare-covered chiropractic	$0.00 copay Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Medicare-covered foot care	$0.00 copay Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Other health professionals	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$1,840.00 copay per stay	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Inpatient mental health care	$1,840.00 copay per stay	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–70: $221.00 copay per day Days 71–100: $0.00 copay per day	Approval required Yes Referral required No Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	Out-of-network	What to know
Outpatient hospital care	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No
Hospital observation services	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No
Ambulatory surgical center	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Outpatient blood	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	Out-of-network	What to know
Diagnostic procedures and tests	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Laboratory services	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Diagnostic radiology (CT, MRI)	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Therapeutic radiology	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No	Approval required Yes Referral required No
X-rays	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	Out-of-network	What to know
Partial hospitalization	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Intensive outpatient program	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Substance use treatment, individual sessions	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Substance use treatment, group sessions	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Opioid treatment program	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Mental health, individual sessions	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Mental health, group sessions	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Psychiatry, individual sessions	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Psychiatry, group sessions	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	Out-of-network	What to know
Occupational therapy	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Physical and speech therapy	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Cardiac rehabilitation	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required No Referral required No
Intensive cardiac rehabilitation	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required No Referral required No
Pulmonary rehabilitation	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required No Referral required No
Supervised exercise for peripheral artery disease	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required No Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	Out-of-network	What to know
Ground ambulance	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No	Approval required Yes
Air ambulance	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No	Approval required Yes
Durable medical equipment	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No	Approval required Yes
Diabetic supplies	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No	Approval required Yes
Diabetic shoes and inserts	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No	Approval required Yes
Diabetic monitors	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	Out-of-network	What to know
Medicare-covered dental	20% coinsurance	30% coinsurance Deductible applies No

Vision benefits

Vision benefits and member costs
Service	In-network	Out-of-network	What to know
Medicare-covered eye exams	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Routine eye examsAdditional plan benefit	$0.00 copay	40% coinsurance Deductible applies No	Approval required Yes Referral required No
Medicare-covered eyewear	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No
Contact lensesAdditional plan benefit	$0.00 copay	40% coinsurance Deductible applies No	Approval required Yes Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0.00 copay	40% coinsurance Deductible applies No	Approval required Yes Referral required No
Eyeglass lensesAdditional plan benefit	$0.00 copay	40% coinsurance Deductible applies No	Approval required Yes Referral required No
Eyeglass framesAdditional plan benefit	$0.00 copay	40% coinsurance Deductible applies No	Approval required Yes Referral required No

Additional network details

These costs apply to the listed service categories and networks.

Vision benefits: additional out-of-network or point-of-service benefits
Service	Network	Your share of the cost	What to know
Eye exams (category)Additional plan benefit	Out-of-network	Confirm with the plan (copay); Confirm with the plan (coinsurance)	Dollar benefit limit applies No
Other Eye Exam ServicesAdditional plan benefit	Out-of-network	40% coinsurance Deductible applies No
Eyewear (category)Additional plan benefit	Out-of-network	Confirm with the plan (copay); Confirm with the plan (coinsurance)	Dollar benefit limit applies No
UpgradesAdditional plan benefit	Out-of-network	40% coinsurance Deductible applies No

Hearing benefits

Hearing benefits and member costs
Service	In-network	Out-of-network	What to know
Medicare-covered hearing exams	20% coinsurance Service-specific deductible No	30% coinsurance Deductible applies No	Approval required Yes Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	Out-of-network	What to know
Annual physical examAdditional plan benefit	$0.00 copay Service-specific deductible No	$0.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No

Additional services and network costs

Additional network details

These costs apply to the listed service categories and networks.

Additional medical services: additional out-of-network or point-of-service benefits
Service	Network	Your share of the cost	What to know
Chiropractic ServicesAdditional plan benefit	Out-of-network	Confirm with the plan (copay); Confirm with the plan (coinsurance)	Dollar benefit limit applies No
Routine Chiropractic CareAdditional plan benefit	Out-of-network	30% coinsurance Deductible applies No
Podiatry Services - Routine Foot CareAdditional plan benefit	Out-of-network	30% coinsurance Deductible applies No	Dollar benefit limit applies No
Medicare-covered preventive servicesMedicare-covered care	Out-of-network	$0.00 copay Deductible applies No
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit	Out-of-network	$0.00 copay Deductible applies No	Dollar benefit limit applies No
Alternative TherapiesAdditional plan benefit	Out-of-network	$0.00 copay Deductible applies No	Dollar benefit limit applies No
Glaucoma ScreeningMedicare-covered care	Out-of-network	30% coinsurance Deductible applies No
Diabetes Self-Management TrainingMedicare-covered care	Out-of-network	30% coinsurance Deductible applies No
Digital Rectal ExamsMedicare-covered care	Out-of-network	30% coinsurance Deductible applies No
EKG after a Welcome to Medicare visitMedicare-covered care	Out-of-network	30% coinsurance Deductible applies No
Medicare Part B insulinMedicare-covered care	Out-of-network	$35.00 copay Deductible applies No

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 6 are exempt from the deductible.

Preferred retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Generic	$0.00	$0.00	$0.00
Tier 2Preferred Brand	25%	25%	25%
Tier 3Non-Preferred Drug	28%	28%	28%
Tier 4Injectable Drugs	25%	25%	25%
Tier 5Specialty Tier	25%	Not listed	Not listed
Tier 6Select Care Drugs	$0.00	$0.00	$0.00

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Generic	$15.00	$30.00	$45.00
Tier 2Preferred Brand	25%	25%	25%
Tier 3Non-Preferred Drug	29%	29%	29%
Tier 4Injectable Drugs	25%	25%	25%
Tier 5Specialty Tier	25%	Not listed	Not listed
Tier 6Select Care Drugs	$0.00	$0.00	$0.00

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Preferred mail order costs

Preferred mail order: initial-coverage cost per prescription fill
Drug tier	60 days	100 days
Tier 1Generic	$0.00	$0.00
Tier 2Preferred Brand	25%	25%
Tier 3Non-Preferred Drug	28%	28%
Tier 4Injectable Drugs	25%	25%
Tier 6Select Care Drugs	$0.00	$0.00

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier	60 days	100 days
Tier 1Generic	$30.00	$45.00
Tier 2Preferred Brand	25%	25%
Tier 3Non-Preferred Drug	29%	29%
Tier 4Injectable Drugs	25%	25%
Tier 6Select Care Drugs	$0.00	$0.00

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Generic	$15.00
Tier 2Preferred Brand	25%
Tier 3Non-Preferred Drug	29%
Tier 4Injectable Drugs	25%
Tier 5Specialty Tier	25%
Tier 6Select Care Drugs	$0.00

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Generic	$15.00
Tier 2Preferred Brand	25%
Tier 3Non-Preferred Drug	29%
Tier 4Injectable Drugs	25%
Tier 5Specialty Tier	25%
Tier 6Select Care Drugs	$0.00

Drug coverage rules and exceptions

Tier 1: Generic

Drugs included in this tier: Both Part D and Excluded Drugs
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Injectable Drugs

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Tier 6: Select Care Drugs

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

View all locations 120 county listings across 1 state or territory