Wellcare Patriot Giveback Open (PPO)

by Wellcare

2026 Medicare Advantage plan available in Maine

Plan ID H2775-116-0

Additional coverage:

HearingVisionDental

Medicare Advantage PPO $0 premium 3.0 Overall

Monthly plan premium $0 / mo

Annual deductible $250 / yr

Max out-of-pocket · in-network $9,250 / yr

3.0 Overall Government Star Rating 2026 · out of 5 stars

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Plan Overview

Wellcare Patriot Giveback Open (PPO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in Maine and offered by the health insurance company Wellcare. This plan's network type is PPO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name Wellcare Patriot Giveback Open (PPO)

Insurance Carrier Wellcare

Plan Type Medicare Advantage Plan Without Prescription Drugs

Network Type PPO

Cost Summary

Wellcare Patriot Giveback Open (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $250 annual deductible and a maximum out-of-pocket cost sharing of $9,250. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $0 / mo

Annual Deductible $250 annual deductible / yr

Max Out-of-Pocket · in-network $9,250 / yr

Primary doctor visit $0 copay

Specialist visit $35 copay

ER visit $115 copay

Ambulance $300 copay

Additional Benefits and Coverage

Wellcare Patriot Giveback Open (PPO) is a Medicare Advantage plan which does not include Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Wellcare Patriot Giveback Open (PPO) includes coverage for hearing, vision, dental.

Part D Prescription Drug Coverage No

Dental Yes

Vision Yes

Hearing Yes

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Not covered

In-home support services Not covered

Home & bathroom safety devices Not covered

Meals for short duration Limited coverage

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: $0 copay
Out-of-network: $25 copay

Specialist visit In-network: $35 copay
Out-of-network: $60 copay

Tests, labs & imaging

Diagnostic tests & procedures In-network: $0-$100 copay
Out-of-network: 40% coinsurance

Lab services In-network: $0-$50 copay
Out-of-network: 40% coinsurance

Diagnostic radiology services (like MRI) In-network: 0%-30% coinsurance
Out-of-network: 40% coinsurance

Outpatient x-rays In-network: $50 copay
Out-of-network: 40% coinsurance

Emergency care $115 copay

Urgent care $40 copay

Hospital Services

Inpatient hospital coverage In-network:
  Tier 1
  $400 per day for days 1-6
  $0 per day for days 7-90
  $0 per stay
Out-of-network:
  30% per day for days 1-90
  0% per stay

Outpatient hospital coverage In-network: $0 copay
Out-of-network: 40% coinsurance

Skilled nursing facility

Skilled nursing facility In-network:
  Tier 1
  $0 per day for days 1-20
  $218 per day for days 21-70
  $0 per day for days 71-100
Out-of-network:
  30% per day for days 1-100
  0% per stay

Preventive services

Preventive services In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance In-network: $300 copay
Out-of-network: $300 copay

Therapy services

Occupational therapy visit In-network: $35 copay
Out-of-network: 40% coinsurance

Physical therapy & speech & language therapy visit In-network: $35 copay
Out-of-network: 40% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist In-network: $0 copay
Out-of-network: 40% coinsurance

Outpatient individual therapy with a psychiatrist In-network: $0 copay
Out-of-network: 40% coinsurance

Outpatient group therapy visit In-network: $0 copay
Out-of-network: 40% coinsurance

Outpatient individual therapy visit In-network: $0 copay
Out-of-network: 40% coinsurance

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Diabetes supplies In-network: $0 copay
Out-of-network: 40% coinsurance

Medicare star rating

Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Wellcare Patriot Giveback Open (PPO) earned an overall rating of 3.0 stars — worse than Maine's state average of 3.8 stars.

Rating category This plan State average

Overall star rating ★ 3.0 3.8

Health plan quality

Summary rating of health plan quality ★ 3.0 3.6

Staying healthy: screenings, tests & vaccines ★ 2.0 3.6

Managing chronic (long-term) conditions ★ 3.0 3.1

Member experience with health plan ★ 2.0 3.4

Member complaints & changes in performance ★ 3.0 4.2

Health plan customer service ★ 4.0 4.0

Extra Benefits

Hearing

Hearing exam In-network: $0 copay
Out-of-network: 40% coinsurance

Fitting/evaluation In-network: $0 copay
Out-of-network: 40% coinsurance

Hearing aids - prescription In-network: $0 copay
Out-of-network: 40% coinsurance

Hearing aids - over the counter Not covered

Preventive dental

Oral exam In-network: $0 copay
Out-of-network: 50% coinsurance

Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance

Fluoride treatment In-network: $0 copay
Out-of-network: 50% coinsurance

Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance

Comprehensive dental

Restorative services In-network: $0 copay
Out-of-network: 50% coinsurance

Endodontics In-network: $0 copay
Out-of-network: 50% coinsurance

Periodontics In-network: $0 copay
Out-of-network: 50% coinsurance

Prosthodontics, removable In-network: $0 copay
Out-of-network: 50% coinsurance

Prosthodontics, fixed In-network: $0 copay
Out-of-network: 50% coinsurance

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery In-network: $0 copay
Out-of-network: 50% coinsurance

Orthodontics Not covered

Adjunctive general services In-network: $0 copay
Out-of-network: 50% coinsurance

Vision

Routine eye exam In-network: $0 copay
Out-of-network: 40% coinsurance

Contact lenses Not covered

Eyeglasses (frames & lenses) Not covered

Eyeglass frames (only) Not covered

Eyeglass lenses (only) Not covered

Upgrades Not covered

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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