Wellcare Patriot Giveback Open (PPO) Medicare Advantage Plan H2117-003 • 2026 • Shiawassee County, MI

Wellcare Patriot Giveback Open Overview

Coverage Overview for Wellcare Patriot Giveback Open

As a Medicare Advantage PPO plan, Wellcare Patriot Giveback Open covers Medicare Part A and Part B services and allows access to Medicare-approved providers. The monthly premium is $0.00, with lower costs when using in-network providers.

Primary care visits have a $0 copay | Out-of-network: $0 copay, specialist visits come with a $30 copay | Out-of-network: $30 copay, urgent care services carry a $50 copay, and ambulance transportation is $225 copay | Out-of-network: $225 copay. These expenses apply toward the annual maximum out-of-pocket (MOOP) limit of $5000.00. After this limit is reached, in-network services are fully covered.

This plan is registered with CMS under Plan ID H2117-003. Cost-sharing details are outlined below.

Out-of-Pocket Costs

Wellcare Patriot Giveback Open has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H2117-003.

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 Star Ratings

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.