Wellcare Patriot Giveback Open (PPO) Medicare Advantage Plan H2775-116 • 2027 • Waldo 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
- Waldo County, ME
- Local Enrollment
- 0 beneficiaries in Waldo County
Wellcare Patriot Giveback Open (PPO) Introduction
This Medicare Advantage PPO plan, Wellcare Patriot Giveback Open, is offered by Wellcare and uses a Preferred Provider Organization (PPO) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $250, and the in-network maximum out-of-pocket is $9850.00. The plan is identified by CMS Plan ID H2775-116.
Enrollment in this plan requires residence in Waldo County, Maine. CMS enrollment data reports 0 plan members in Waldo County. New members can call the plan directly at (844)480-0680 (TTY 711) for assistance.
Compare Similar Plans in Waldo County
Compare this plan with the two most-enrolled PPO plans available in Waldo County, Maine. Enrollment is based on CMS local enrollment data.
| Plan Detail | Wellcare Patriot Giveback Open | HumanaChoice Giveback H7617-046 | Wellcare Low Premium Open |
|---|---|---|---|
| CMS Plan ID | H2775-116-0 |
H7617-046-0 |
H2775-109-0 |
| Local Enrollment | 0 | 132 | 124 |
| Monthly Premium | $0.00 | $0.00 | $44.50 |
| Medical Deductible | $250 | $700 | $0.00 |
| Maximum Out-of-Pocket | $9,850.00 | $7,150.00 | $9,850.00 |
| Part B Giveback | −$75.00 reduction | −$40.00 reduction | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $35 copay | $45 copay | $40 copay |
| Part D Deductible | Not Applicable | $700.00 | $700.00 |
| CMS Star Rating | 3.0 | 4.5 | 3.0 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Want to explore more options? Browse all Medicare Advantage plans in Waldo County, or compare Medicare Advantage plans across Maine, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
Wellcare Patriot Giveback Open includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with 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)
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.
| 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 Advantage Plan Availability
Wellcare Patriot Giveback Open is available to eligible Medicare beneficiaries residing in Waldo County, Maine, including communities such as Palermo, Winterport, Lincolnville, Belfast, Brooks, Freedom, Morrill, Searsport, Stockton Springs, Thorndike, Unity, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | November 10, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Wellcare (official source) | http://www.wellcare.com/medicare | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Provenance documentation for this data is maintained under 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.