Wellcare Premium Enhanced (PFFS)

Wellcare Premium Enhanced (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 2026.

It's important to know that Wellcare Premium Enhanced (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 Enhanced (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 Enhanced (PFFS) plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generics and Tier 2 generics when filled at a preferred pharmacy or through preferred mail order. Tier 6 select care drugs are also highly affordable, featuring no copay at both preferred and standard pharmacies. For brand-name and specialty medications, costs are based on coinsurance. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs incur a 38% coinsurance at preferred pharmacies and 39% at standard pharmacies. If you use a standard pharmacy for generic medications, copays range from $5 to $10 for a one-month supply of Tier 1 and Tier 2 drugs.

Additional Benefits

The Wellcare Premium Enhanced (PFFS) plan offers robust medical coverage featuring no copay and no coinsurance for primary care doctor visits, while specialist visits require a $20 copay. Inpatient hospital stays require a $295 daily copay for days one through five and no copay for days six through 90, with no coinsurance. Emergency room care is covered with a $150 copay, and outpatient hospital services range from no copay up to a $300 copay. For routine and supplemental care, the plan features no copay for annual physicals, fitness benefits, and routine hearing and vision exams. Covered preventive and comprehensive dental services also have no copay and no coinsurance up to a generous $2,000 annual maximum. Additionally, home health services and diagnostic lab tests require no copay, while durable medical equipment and dialysis services are covered with a 20% coinsurance.