Wellcare Patriot Giveback Open (PPO) Medicare Advantage Plan H3975-002 • 2026 • Gallatin County, KY

Wellcare Patriot Giveback Open Overview

Plan Details for Wellcare Patriot Giveback Open

This Medicare Advantage Preferred Provider Organization (PPO) plan provides access to Medicare-approved providers and covers Medicare Part A and Part B services. The monthly premium is $0.00, with lower costs when using in-network providers.

Primary care visits have a $0 copay | Out-of-network: $5 copay, specialist visits come with a $45 copay | Out-of-network: $50 copay, urgent care services carry a $25 copay, and ambulance transportation is $325 copay | Out-of-network: $325 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6000.00. Once this limit is reached, in-network services are fully covered.

This plan is listed by CMS under Plan ID H3975-002. Cost-sharing details for key services are provided below.

Cost Sharing Expenses

Wellcare Patriot Giveback Open includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H3975-002.

Certain preventive services are covered 100% by Wellcare Patriot Giveback Open as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

Medicare Plan Star Ratings

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.