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Wellcare Patriot Giveback Open (PPO)

H6713 - 003 - 0
3 out of 5 stars (3 / 5)

wellcare medicare provider logo

Wellcare Patriot Giveback Open (PPO) is a Medicare Advantage Plan by Wellcare.

This page features plan details for 2025 Wellcare Patriot Giveback Open (PPO) H6713 – 003 – 0.

IMPORTANT: This page features the 2025 version of this plan. See the 2025 version using the link below:

2025 Wellcare Patriot Giveback Open (PPO) H6713 - 003 - 0

Locations

Wellcare Patriot Giveback Open (PPO) is offered in the following locations.

Adams County, Illinois
Bond County, Illinois
Boone County, Illinois

Click to see more locations

Plan Overview

Wellcare Patriot Giveback Open (PPO) offers the following coverage and cost-sharing.

Insurer:Wellcare
Health Plan Deductible:$275 annual deductible
MOOP:$8,950 In and Out-of-network
$5,500 In-network
Drugs Covered:No

Ready to sign up for Wellcare Patriot Giveback Open (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Wellcare Patriot Giveback Open (PPO) qualifies for a monthly Medicare Give Back Benefit of $110.00.

Premium Reduction:$110.00

Premium Breakdown

Wellcare Patriot Giveback Open (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$185.00 $0.00 $110.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Wellcare Patriot Giveback Open (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Endodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Periodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Restorative Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Fluoride Treatment
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Other Diagnostic Dental Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Other Preventive Dental Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Lab services
    • Out-of-Network: 40% coinsurance (Authorization Required)
    • In-Network: $0-50 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $50 copay (Authorization Required)
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-350 copay (Authorization Required)
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-100 copay (Authorization Required)

Doctor visits

  • Specialist
    • Out-of-Network: $75 copay per visit (Authorization Required)
  • Primary
    • Out-of-Network: $45 copay per visit
  • Specialist
    • In-Network: $45 copay per visit (Authorization Required)
  • Primary
    • In-Network: $0 copay

Emergency care/Urgent care

  • Emergency
    • $125 copay per visit (always covered)
  • Urgent care
    • $40 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $45 copay (Authorization Required)
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • Out-of-Network: 40% coinsurance (Authorization Required)

Ground ambulance

    • Out-of-Network: $290 copay
    • In-Network: $290 copay

Health plan deductible

    • $275 annual deductible

Hearing

  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Hearing aids
    • In-Network: $0 copay (Limits Apply, Authorization Required)
    • Out-of-Network: 40% coinsurance (Limits Apply, Authorization Required)
  • Medicare-Covered Hearing Exam
    • In-Network: $45 copay (Authorization Required)
  • Hearing aids OTC
    • Not covered
  • Fitting/evaluation
    • Out-of-Network: 40% coinsurance (Limits Apply, Authorization Required)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $75 copay (Authorization Required)

Inpatient hospital coverage

    • Out-of-Network: 20% per day for days 1 through 90 (Authorization Required)
    • In-Network: $375 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $8,950 In and Out-of-network
      $5,500 In-network

Medical equipment/supplies

  • Diabetes supplies
    • In-Network: $0 copay per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • Out-of-Network: 0-40% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 0-40% coinsurance (Authorization Required)
  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • In-Network: $375 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
  • Outpatient individual therapy visit
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $0 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $0 copay (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $0 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Inpatient hospital – psychiatric
    • Out-of-Network: 20% per day for days 1 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $0 copay (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $0-350 copay per visit (Authorization Required)
    • Out-of-Network: 40% coinsurance per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $45 copay (Authorization Required)
  • Occupational therapy visit
    • In-Network: $45 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 40% coinsurance (Authorization Required)

Skilled Nursing Facility

    • Out-of-Network: 30% per day for days 1 through 100 (Authorization Required)
    • In-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 50
      $0 per day for days 51 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Eyeglass lenses
    • Out-of-Network: 40% coinsurance (Limits Apply, Authorization Required)
  • Eyeglasses (frames and lenses)
    • Out-of-Network: 40% coinsurance (Limits Apply, Authorization Required)
  • Upgrades
    • Out-of-Network: 40% coinsurance (Limits Apply, Authorization Required)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Eyeglass frames
    • Out-of-Network: 40% coinsurance (Limits Apply, Authorization Required)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Routine eye exam
    • Out-of-Network: 40% coinsurance (Limits Apply, Authorization Required)
  • Upgrades
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Other
    • Not covered
  • Contact lenses
    • Out-of-Network: 40% coinsurance (Limits Apply, Authorization Required)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply, Authorization Required)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for Wellcare Patriot Giveback Open (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

For the 2025 version of Wellcare Patriot Giveback Open (PPO)? see 2025 Wellcare Patriot Giveback Open (PPO) at MedicareAdvantageRX.com.

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