2027 Medicare Advantage plan
Wellcare Magnolia Health Dual Access Open (PPO D-SNP): 2027 benefits and costs
Wellcare PPO D-SNP Special Needs Plan
CMS plan ID: H0074-004-0 · Plan year: 2027
Wellcare Magnolia Health Dual Access Open (PPO D-SNP) is a 2027 Medicare Advantage plan offered by Wellcare. It is listed in Mississippi.
2027 plan costs at a glance
Costs shown are before Medicaid or Extra Help; your costs depend on your eligibility and assistance.
- Organization
- Wellcare
- Plan organization
- WELLCARE OF MISSISSIPPI, INC.
- Parent company
- Centene Corporation
- Plan type
- PPO D-SNP
- Part C premium
- $0.00
- Part D premium
- $6.30
- 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.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | 20% coinsurance
| 30% coinsurance
| |
| Specialist visit | 20% coinsurance
| 30% coinsurance
|
|
| Telehealth | $0.00 to $40.00 copay; 20% coinsurance
| Not summarized. Check coverage with the plan. |
|
| 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
| $0.00 copay
|
|
| Dialysis | 20% coinsurance
| 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 0% to 20% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 0% to 20% coinsurance
|
|
| Kidney disease education services | 20% coinsurance
| 30% coinsurance
|
|
| Medicare-covered chiropractic | $0.00 copay
| 30% coinsurance
|
|
| Medicare-covered foot care | $0.00 copay
| 30% coinsurance
|
|
| Other health professionals | 20% coinsurance
| 30% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $1,755.00 copay per stay |
|
| Inpatient mental health care | $1,755.00 copay 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 |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | 20% coinsurance
| 30% coinsurance
| |
| Hospital observation services | 20% coinsurance
| 30% coinsurance
| |
| Ambulatory surgical center | 20% coinsurance
| 30% coinsurance
|
|
| Outpatient blood | 20% coinsurance
| 30% coinsurance
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | 20% coinsurance
| 30% coinsurance
|
|
| Laboratory services | 20% coinsurance
| 30% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | 20% coinsurance
| 30% coinsurance
|
|
| Therapeutic radiology | 20% coinsurance
| 20% coinsurance
|
|
| X-rays | 20% coinsurance
| 30% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | 20% coinsurance
| 30% coinsurance
|
|
| Intensive outpatient program | 20% coinsurance
| 30% coinsurance
|
|
| Substance use treatment, individual sessions | 20% coinsurance
| 30% coinsurance
|
|
| Substance use treatment, group sessions | 20% coinsurance
| 30% coinsurance
|
|
| Opioid treatment program | 20% coinsurance
| 30% coinsurance
|
|
| Mental health, individual sessions | 20% coinsurance
| 30% coinsurance
|
|
| Mental health, group sessions | 20% coinsurance
| 30% coinsurance
|
|
| Psychiatry, individual sessions | 20% coinsurance
| 30% coinsurance
|
|
| Psychiatry, group sessions | 20% coinsurance
| 30% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | 20% coinsurance
| 30% coinsurance
|
|
| Physical and speech therapy | 20% coinsurance
| 30% coinsurance
|
|
| Cardiac rehabilitation | 20% coinsurance
| 30% coinsurance
|
|
| Intensive cardiac rehabilitation | 20% coinsurance
| 30% coinsurance
|
|
| Pulmonary rehabilitation | 20% coinsurance
| 30% coinsurance
|
|
| Supervised exercise for peripheral artery disease | 20% coinsurance
| 30% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | 20% coinsurance
| 20% coinsurance
|
|
| Air ambulance | 20% coinsurance
| 20% coinsurance
|
|
| Durable medical equipment | 20% coinsurance
| 20% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 20% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 20% coinsurance
|
|
| Diabetic supplies | 20% coinsurance
| 20% coinsurance
|
|
| Diabetic shoes and inserts | 20% coinsurance
| 20% coinsurance
|
|
| Diabetic monitors | 20% coinsurance
| 20% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | 20% coinsurance | 30% coinsurance
| |
| Oral examsAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Dental X-raysAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Other diagnostic dentalAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Dental cleaningAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| FluorideAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Other preventive dentalAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Restorative dental careAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | $0.00 copay | 50% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | $0.00 copay | 50% coinsurance
| |
| Removable dentures (prosthodontics)Additional plan benefit | $0.00 copay | 50% coinsurance
| |
| Oral surgeryAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Other dental servicesAdditional plan benefit | $0.00 copay | 50% coinsurance
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | 20% coinsurance
| 30% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay | 40% coinsurance
|
|
| Medicare-covered eyewear | 20% coinsurance
| 30% coinsurance
|
|
| Contact lensesAdditional plan benefit | $0.00 copay | 40% coinsurance
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0.00 copay | 40% coinsurance
|
|
| Eyeglass lensesAdditional plan benefit | $0.00 copay | 40% coinsurance
|
|
| Eyeglass framesAdditional plan benefit | $0.00 copay | 40% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| 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) |
|
| Other Eye Exam ServicesAdditional plan benefit | Out-of-network | 40% coinsurance
| |
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| UpgradesAdditional plan benefit | Out-of-network | 40% coinsurance
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | 20% coinsurance
| 30% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0.00 copay | 40% coinsurance
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0.00 copay | 40% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $0.00 copay
| 40% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0.00 copay
| $0.00 copay
| |
| Limited-duration mealsAdditional plan benefit | $0.00 copay
| $0.00 copay
|
|
| Annual physical examAdditional plan benefit | $0.00 copay
| $0.00 copay
|
|
| Fitness benefitAdditional plan benefit | $0.00 copay
| $0.00 copay
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| 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) |
|
| Routine Chiropractic CareAdditional plan benefit | Out-of-network | 30% coinsurance
| |
| Podiatry Services - Routine Foot CareAdditional plan benefit | Out-of-network | 30% coinsurance
|
|
| Transportation to plan-approved health locationsAdditional plan benefit | Out-of-network | 75% coinsurance
|
|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | $0.00 copay
| |
| Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit | Out-of-network | $0.00 copay
|
|
| Personal emergency alert systemAdditional plan benefit | Out-of-network | $0.00 copay
|
|
| Alternative TherapiesAdditional plan benefit | Out-of-network | $0.00 copay
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | 30% coinsurance
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | 30% coinsurance
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | 30% coinsurance
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | 30% coinsurance
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | $35.00 copay
|
Allowances and optional benefits
SSBCI OTC DVH
One shared limit covers the listed services, not a separate allowance for each service.
- Services sharing this allowance
- Over-the-counter health items; Oral Exams; Dental X-Rays; Other Diagnostic Dental Services; Dental cleaning; Fluoride Treatment; Other Preventive Dental Services; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Removable dentures (prosthodontics); Oral and Maxillofacial Surgery; Adjunctive General Services; Routine Eye Exams; Other Eye Exam Services; Contact Lenses; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames; Upgrades; Routine Hearing Exams; Hearing aid fitting and evaluation; Prescription Hearing Aids (all types); Additional Benefits for SSBCI
- Service categories that apply to the combined supplemental benefits group for Special Supplemental Benefits for Chronically Ill (SSBCI) package(s)
- Food and produce (SSBCI: SSBCI OTC DVH); Additional meal benefits (SSBCI: SSBCI OTC DVH); Pest control (SSBCI: SSBCI OTC DVH); Transportation for non-medical needs (SSBCI: SSBCI OTC DVH); Social support benefit (SSBCI: SSBCI OTC DVH); Support for daily living (SSBCI: SSBCI OTC DVH)
- How benefits are provided
- Debit Card; Reimbursement
- Advance choice of benefits required
- No
- Shared benefit limit
- $62.00
- How often this limit applies
- Every one month
- Are the benefits combined such that a single benefit maximum available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?
- Yes
- Shared limit on visits or trips
- No
Benefits for qualifying members
SSBCI OTC DVH
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Overweight, obesity, and metabolic syndrome; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation; Immunodeficiency and Immunosuppressive disorders; Conditions associated with cognitive impairment; Conditions with functional challenges; Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell; Conditions that require continued therapy services in order for individuals to maintain or retain functioning; Other 1
- Qualifying conditions
- Endometriosis
- Included services
- Food and produce; Additional meal benefits; Pest control; Transportation for non-medical needs; Social support benefit; Support for daily living
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- Yes
- Services exempt from the deductible
- Food and produce; Additional meal benefits; Pest control; Transportation for non-medical needs; Social support benefit; Support for daily living
- Package limit
- $0.00
- How often this limit applies
- Every month
- How benefits are provided
- Debit Card; Reimbursement
- Services sharing the package limit
- Food and produce; Additional meal benefits; Pest control; Transportation for non-medical needs; Social support benefit; Support for daily living
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.
| 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 | 30% | 30% | 30% |
| 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.
| 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 | 30% | 30% | 30% |
| 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
| Drug tier | 60 days | 100 days |
|---|---|---|
| Tier 1Generic | $0.00 | $0.00 |
| Tier 2Preferred Brand | 25% | 25% |
| Tier 3Non-Preferred Drug | 30% | 30% |
| Tier 4Injectable Drugs | 25% | 25% |
| Tier 6Select Care Drugs | $0.00 | $0.00 |
Standard mail order costs
| Drug tier | 60 days | 100 days |
|---|---|---|
| Tier 1Generic | $30.00 | $45.00 |
| Tier 2Preferred Brand | 25% | 25% |
| Tier 3Non-Preferred Drug | 30% | 30% |
| Tier 4Injectable Drugs | 25% | 25% |
| Tier 6Select Care Drugs | $0.00 | $0.00 |
Long-term care pharmacy costs
| Drug tier | 31 days |
|---|---|
| Tier 1Generic | $15.00 |
| Tier 2Preferred Brand | 25% |
| Tier 3Non-Preferred Drug | 30% |
| Tier 4Injectable Drugs | 25% |
| Tier 5Specialty Tier | 25% |
| Tier 6Select Care Drugs | $0.00 |
Out-of-network pharmacy costs
| Drug tier | 30 days |
|---|---|
| Tier 1Generic | $15.00 |
| Tier 2Preferred Brand | 25% |
| Tier 3Non-Preferred Drug | 30% |
| 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 51 county listings across 1 state or territory
Mississippi
- Attala, Mississippi
- Bolivar, Mississippi
- Carroll, Mississippi
- Claiborne, Mississippi
- Clarke, Mississippi
- Coahoma, Mississippi
- Copiah, Mississippi
- Covington, Mississippi
- DeSoto, Mississippi
- Forrest, Mississippi
- George, Mississippi
- Greene, Mississippi
- Hancock, Mississippi
- Harrison, Mississippi
- Hinds, Mississippi
- Holmes, Mississippi
- Humphreys, Mississippi
- Jackson, Mississippi
- Jasper, Mississippi
- Jefferson Davis, Mississippi
- Jones, Mississippi
- Kemper, Mississippi
- Lauderdale, Mississippi
- Lawrence, Mississippi
- Leake, Mississippi
- Leflore, Mississippi
- Lincoln, Mississippi
- Madison, Mississippi
- Marion, Mississippi
- Marshall, Mississippi
- Montgomery, Mississippi
- Neshoba, Mississippi
- Newton, Mississippi
- Panola, Mississippi
- Perry, Mississippi
- Pike, Mississippi
- Quitman, Mississippi
- Rankin, Mississippi
- Scott, Mississippi
- Simpson, Mississippi
- Smith, Mississippi
- Stone, Mississippi
- Tallahatchie, Mississippi
- Tate, Mississippi
- Tunica, Mississippi
- Walthall, Mississippi
- Warren, Mississippi
- Washington, Mississippi
- Wayne, Mississippi
- Yalobusha, Mississippi
- Yazoo, Mississippi