Wellcare Patriot Giveback Open (PPO) Medicare Advantage Plan H2775-116 • 2027 • Cumberland County, ME
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $250
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- −$75.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Cumberland County, ME
- Local Enrollment
- 0 beneficiaries in Cumberland County
Wellcare Patriot Giveback Open (PPO) Introduction
CMS Plan ID H2775-116 identifies Wellcare Patriot Giveback Open, a Medicare Advantage PPO plan offered by Wellcare. The plan uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $250 medical deductible, and $9850.00 in-network maximum out-of-pocket.
Eligible Medicare beneficiaries residing in Cumberland County, Maine can enroll in this plan. CMS reports local enrollment of 0 beneficiaries for this plan in Cumberland County. New members can contact the plan at (844)480-0680 (TTY 711) for help and additional plan information.
Compare Similar Plans in Cumberland County
Compare this plan with the two most-enrolled PPO plans available in Cumberland County, Maine. Enrollment is based on CMS local enrollment data.
| Plan Detail | Wellcare Patriot Giveback Open | HumanaChoice H5216-175 | HumanaChoice Giveback H7617-046 |
|---|---|---|---|
| CMS Plan ID | H2775-116-0 |
H5216-175-0 |
H7617-046-0 |
| Local Enrollment | 0 | 623 | 568 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $250 | $200 | $700 |
| Maximum Out-of-Pocket | $9,850.00 | $7,150.00 | $7,150.00 |
| Part B Giveback | −$75.00 reduction | Not offered | −$40.00 reduction |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $35 copay | $35 copay | $45 copay |
| Part D Deductible | Not Applicable | $600.00 | $700.00 |
| CMS Star Rating | 3.0 | 4.0 | 4.5 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Wellcare Patriot Giveback Open has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H2775-116.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H2775-116-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $25 copay - Specialist
- In-network: $35 copay
Out-of-network: $60 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $0 copay - Telehealth benefit
- In-network: $0-$40 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: 0%-30% coinsurance
Out-of-network: 40% coinsurance - Lab services
- In-network: $0-$50 copay
Out-of-network: 40% coinsurance - Outpatient x-rays
- In-network: $50 copay
Out-of-network: 40% coinsurance - Diagnostic tests and procedures
- In-network: $0-$100 copay
Out-of-network: 40% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $115 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $40 copay
- Inpatient hospital care
- 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 - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 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 - Ground ambulance
- In-network: $290 copay
Out-of-network: $290 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $0 copay
Out-of-network: 40% coinsurance - Outpatient group therapy
- In-network: $0 copay
Out-of-network: 40% coinsurance - Inpatient psychiatric hospital care
- 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
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $35 copay
Out-of-network: 40% coinsurance - Occupational therapy
- In-network: $35 copay
Out-of-network: 40% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: 40% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 35% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: 50% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: 50% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: 50% coinsurance - Periodontics
- In-network: $0 copay
Out-of-network: 50% coinsurance - Endodontics
- In-network: $0 copay
Out-of-network: 50% coinsurance - Restorative services
- In-network: $0 copay
Out-of-network: 50% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Out-of-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: 40% coinsurance - Contact lenses
- Not covered
- Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- Not covered
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
Out-of-network: 40% coinsurance - Fitting/evaluation
- In-network: $0 copay
Out-of-network: 40% coinsurance - Prescription hearing aids
- In-network: $0 copay
Out-of-network: 40% coinsurance - OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- In-network: $0 copay
Out-of-network: $0 copay - Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
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.
CMS 5-Star Performance Ratings (Contract ID: H2775)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Wellcare
- Website
- Wellcare Plan Page
- Providers
- Wellcare Providers Page
- Formulary
- Wellcare Formulary Page
- Pharmacy
- Wellcare Pharmacy Page
- New Member Health Plan Help
- (844)480-0680
- New Member Health Plan TTY
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Wellcare (official source) | http://go.wellcare.com/Medicare | October 4, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.