Wellcare Premium Ultra (PFFS)

Wellcare Premium Ultra (PFFS) is a PFFS plan offered by American Progressive Life & Hlth Ins Company of NY available for the 2026 plan year to people living in Select counties in NY. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that Wellcare Premium Ultra (PFFS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about Wellcare Premium Ultra (PFFS).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The Wellcare Premium Ultra (PFFS) medicare prescription drug coverage features a $615 annual drug deductible. This plan offers no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filled at preferred pharmacies or through preferred mail order. If you choose standard pharmacies or standard mail order, copays for these lower-tier drugs range from $5 to $30 depending on the tier and supply. For brand-name and specialty medications, costs are structured as coinsurance. Tier 3 preferred brands and Tier 5 specialty drugs both require 25% coinsurance, while Tier 4 non-preferred drugs carry a 37% coinsurance at preferred locations and 38% at standard locations. These clear cost-sharing tiers help you understand your out-of-pocket prescription expenses with the Wellcare Premium Ultra (PFFS) plan.

Additional Benefits

The Wellcare Premium Ultra (PFFS) plan offers comprehensive medical coverage featuring no copay for primary care visits and a $20 copay for specialists and therapy services. Inpatient hospital stays require a $500 copay per admission with no coinsurance, while outpatient hospital services range from no copay up to $200. Emergency care is covered with a $150 copay, and skilled nursing facility stays feature no copay for days 1 to 20 and 41 to 100, though days 21 to 40 require a $218 daily copay. For supplemental care, the plan provides routine vision and dental services with no copay and no coinsurance, subject to specific annual benefit maximums of $100 for eyewear and $2,000 for dental treatments. Diagnostic tests, lab services, and home health services are available with no copay or coinsurance, while dialysis and durable medical equipment require a 20% coinsurance with no copay. Routine hearing exams also feature no copay, but prescription hearing aids, transportation, and over-the-counter items are not covered under this plan.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.