South Carolina Medicare Advantage Plan (2025 Plan)
Monthly Premium
Your Cost
$0
by Wellcare
Additional Coverage
HearingVisionDental
Overall Government Star Rating
3.5
out of 5 stars
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Plan Overview
Plan Name
Wellcare Mutual of Omaha Simple Open (PPO)
Insurance Carrier
Wellcare
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
PPO
Wellcare Mutual of Omaha Simple Open (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in South Carolina and offered by the health insurance company Wellcare. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$4,150
Primary doctor visit
$0 copay
Specialist visit
$20 copay per visit
ER visit
$140 copay per visit (always covered)
Ambulance
$250 copay
Wellcare Mutual of Omaha Simple Open (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $6,200 In and Out-of-network
$4,150 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Wellcare Mutual of Omaha Simple Open (PPO) are defined below.
Additional Benefits and Coverage
Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing
Wellcare Mutual of Omaha Simple Open (PPO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Wellcare Mutual of Omaha Simple Open (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Wellcare Mutual of Omaha Simple Open (PPO) includes coverage for the following additional benefits:
Other benefits
Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage
Comparing the Quality Score of Wellcare Mutual of Omaha Simple Open (PPO) to Other Plans in South Carolina
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Wellcare Mutual of Omaha Simple Open (PPO) received an overall government quality rating of 3.5 stars out of 5 stars.
Wellcare Mutual of Omaha Simple Open (PPO) performed worse than South Carolina’s State average overall quality score of 3.8 stars.
This Plan’s 5-star Gov’t Quality Score
South Carolina State Average Score
Overall Government 5 Star Quality Rating
3.5
3.8
Summary rating of health plan quality
3.5
3.8
Staying healthy: screenings, tests, & vaccines
3
3.5
Managing chronic (long term) conditions
3
3.4
Member experience with health plan
4
3.9
Member complaints & changes in the health plan's performance
3
4.0
Health plan customer service
4
4.1
Summary rating of drug plan quality
3.5
3.7
Drug plan customer service
4
4.0
Member complaints & changes in the drug plan's performance
4
3.8
Member experience with the drug plan
4
4.1
Drug safety & accuracy of drug pricing
3
3.2
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Wellcare Mutual of Omaha Simple Open (PPO) received 3.5 stars for its health plan quality score which is worse than the South Carolina State average health plan quality score of 3.8 stars.
Wellcare Mutual of Omaha Simple Open (PPO) received 3.5 stars for its drug plan quality score which is worse than the South Carolina State average drug plan quality score of 3.7 stars.
In-network: $350 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 through 100
Out-of-network: 40% per day for days 1 through 90
0% per day for days 91 through 100
Outpatient hospital coverage
In-network: $0-350 copay per visit
Out-of-network: 50% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$214 per day for days 21 through 60
$0 per day for days 61 through 100
Out-of-network: 50% per day for days 1 through 100
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: $250 copay
Out-of-network: $250 copay
Therapy services
Occupational therapy visit
In-network: $20 copay
Out-of-network: $35 copay
Physical therapy & speech & language therapy visit
In this article we rank South Carolina Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.
The Medicare landscape in South Carolina is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in South Carolina.
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