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Wellcare Patriot Giveback Open (PPO) Medicare Advantage Plan H5439-010 • 2027

CMS Rating: ☆☆☆☆☆ (3.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$200
Maximum Out-of-Pocket
$6750.00In-network
Part B Giveback
−$10.00 reduction
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
758 beneficiaries
Last update:

Wellcare Patriot Giveback Open (PPO) Introduction

This Medicare Advantage PPO plan, Wellcare Patriot Giveback Open, is offered by Wellcare By Health Net 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 $200, and the in-network maximum out-of-pocket is $6750.00. The plan is identified by CMS Plan ID H5439-010.

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 H5439-010.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay
Out-of-network: $30 copay		 In-network: $0 copay
Out-of-network: $30 copay
Specialist In-network: $30 copay
Out-of-network: $60 copay		 In-network: $25 copay
Out-of-network: $60 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Telehealth benefit In-network: $0-$50 copay In-network: $0-$50 copay
Routine chiropractic In-network: $15 copay
Out-of-network: 20% coinsurance		 In-network: $15 copay
Out-of-network: 25% coinsurance
Fitness benefits Coming soon In-network: $0 copay
Out-of-network: $0 copay
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$500 copay
Out-of-network: 20% coinsurance		 In-network: $0-$500 copay
Out-of-network: 20% coinsurance
Lab services In-network: $0-$50 copay
Out-of-network: 20% coinsurance		 In-network: $0-$50 copay
Out-of-network: 20% coinsurance
Outpatient x-rays In-network: $50 copay
Out-of-network: 20% coinsurance		 In-network: $50 copay
Out-of-network: 20% coinsurance
Diagnostic tests and procedures In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance		 In-network: $0 copay, 20% coinsurance
Out-of-network: 20% coinsurance

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $130 copay $130 copay
Worldwide emergency care Coming soon $130 copay
Urgent care $50 copay $50 copay
Inpatient hospital care In-network:
Tier 1
$525 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
30% per day for days 1-90
0% per stay		 In-network:
Tier 1
$525 per day for days 1-5
$0 per day for days 6-90
$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 21-60
$0 per day for days 61-100
Out-of-network:
30% per day for days 1-100
0% per stay		 In-network:
Tier 1
$0 per day for days 1-20
$218 per day for days 21-60
$0 per day for days 61-100
Out-of-network:
30% per day for days 1-100
0% per stay
Ground ambulance In-network: $175 copay
Out-of-network: $175 copay		 In-network: $175 copay
Out-of-network: $175 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $0 copay
Out-of-network: 20% coinsurance		 In-network: $0 copay
Out-of-network: 20% coinsurance
Outpatient group therapy In-network: $0 copay
Out-of-network: 20% coinsurance		 In-network: $0 copay
Out-of-network: 20% coinsurance
Inpatient psychiatric hospital care In-network:
Tier 1
$525 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
30% per day for days 1-90
0% per stay		 In-network:
Tier 1
$525 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
30% per day for days 1-90
0% per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $25 copay
Out-of-network: 20% coinsurance		 In-network: $25 copay
Out-of-network: 20% coinsurance
Occupational therapy In-network: $25 copay
Out-of-network: 20% coinsurance		 In-network: $25 copay
Out-of-network: 20% coinsurance

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: $0 copay
Out-of-network: 20% coinsurance		 In-network: $0 copay
Out-of-network: 20% coinsurance
Durable medical equipment In-network: 20% coinsurance
Out-of-network: 20% coinsurance		 In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthetics In-network: 20% coinsurance
Out-of-network: 20% coinsurance		 In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 70% coinsurance
Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 70% coinsurance
Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 70% coinsurance
Periodontics In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: 40% coinsurance
Out-of-network: 70% coinsurance
Endodontics In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: 40% coinsurance
Out-of-network: 70% coinsurance
Restorative services In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: 40% coinsurance
Out-of-network: 70% coinsurance
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: 40% coinsurance
Out-of-network: 70% coinsurance

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Contact lenses In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglass frames only In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglass lenses only In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Upgrades In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Fitting/evaluation In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
Prescription hearing aids In-network: $0 copay
Out-of-network: 40% coinsurance		 In-network: $0 copay
Out-of-network: 40% coinsurance
OTC hearing aids Not covered Not covered

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered 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: H5439)

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.

2027 Medicare Star Ratings for Contract H5439
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 ☆☆☆☆☆

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About Wellcare Patriot Giveback Open (PPO)

How much does plan H5439-010 cost per month?

The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.

What is the annual out-of-pocket maximum (MOOP) for this plan?

The annual in-network MOOP is $6750.00 for 2027. After this limit is reached, covered in-network services are fully paid.

What is the total enrollment for plan H5439-010?

Total enrollment is 758 beneficiaries based on the latest CMS data.

Is there a Part D deductible for this plan?

The Part D deductible is $0.00.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
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.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Wellcare By Health Net (official source) http://go.wellcare.com/OR October 4, 2026
CMS.gov Medicare Advantage Plan Fact Sheet 25 May, 2025
Medicare.gov Joining a plan 25 May, 2025
Medicare.gov Compare Original Medicare & Medicare Advantage 25 May, 2025

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.