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Wellcare Premium Ultra (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Premium Ultra (PFFS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Premium Ultra (PFFS) in 2025, please refer to our full plan details page.
Wellcare Premium Ultra (PFFS) is a PFFS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in NY. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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.
For Wellcare Premium Ultra (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $117.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $420.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3400.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $3400.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Wellcare Premium Ultra (PFFS)
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Drug Coverage
The Wellcare Premium Ultra (PFFS) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay varying costs depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and mail order pharmacies, and a $10 copay at standard pharmacies. The plan offers an enhanced alternative drug benefit.
Additional Benefits
The Wellcare Premium Ultra (PFFS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $500 copay, while outpatient services may have copays ranging from $0 to $200. Emergency services and primary care visits have a $140 and $0 copay, respectively. The plan also covers preventive, hearing, vision, and dental services. Preventive services have no copay for an annual physical, and hearing services include hearing exams and hearing aids with no copay. Vision benefits include eye exams and eyewear with no copay, and dental services have a $20 copay for Medicare dental services. Additionally, the plan includes coverage for home health, skilled nursing facilities, and medical equipment with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $500 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-120, up to 30 additional days per benefit period. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$200, Observation Services with a copay of $140-$200, Ambulatory Surgical Center (ASC) Services with a $150 copay, Outpatient Substance Abuse services with a $20 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Premium Ultra (PFFS) plan. Ground and Air Ambulance Services have a $350 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Wellcare Premium Ultra (PFFS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $35 copay; all three have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Premium Ultra (PFFS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $20 copay, and mental health specialty services with a $20 copay. The plan also covers physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0-$35, and opioid treatment program services with a $20 copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with copays for fitness benefits, remote access technologies, and alternative therapies. Kidney Disease Education Services have a 20% coinsurance, while Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The Wellcare Premium Ultra (PFFS) plan covers hearing exams with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $350 per ear per year with no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $20, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, has no copay, and a combined maximum benefit of $100 per year applies to both in-network and out-of-network services.
Dental Services See details
The Wellcare Premium Ultra (PFFS) plan covers Medicare dental services with a $20 copay, and other dental services with no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable & fixed), and oral and maxillofacial surgery. Orthodontic services are covered up to a $2,000 maximum benefit per year, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Premium Ultra (PFFS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered under the Wellcare Premium Ultra (PFFS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have no copay. Diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Premium Ultra (PFFS) plan. Lab Services have no copay, Diagnostic Procedures/Tests have no copay, and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of up to $200.00, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered under the Wellcare Premium Ultra (PFFS) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Wellcare Premium Ultra (PFFS) plan. While the plan covers Cardiac Rehabilitation Services, it does not cover any of the specific sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Wellcare Premium Ultra (PFFS) plan. There is no copay for days 1-20 and days 51-100, but there is a $203 copay for days 21-50.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, while acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered. The OTC benefit has a maximum coverage amount of $50 every three months.
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