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Wellcare Advantage Premium Enhanced (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Advantage Premium Enhanced (PFFS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Advantage Premium Enhanced (PFFS) in 2025, please refer to our full plan details page.
Wellcare Advantage 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 2025.
It's important to know that Wellcare Advantage Premium Enhanced (PFFS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Advantage 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.
For Wellcare Advantage Premium Enhanced (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6700.00 (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 $6700.00 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:
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Drug Coverage
Prescription drugs are not covered by Wellcare Advantage Premium Enhanced (PFFS).
Additional Benefits
The Wellcare Advantage Premium Enhanced (PFFS) plan offers comprehensive coverage with varying costs. Hospital stays have a copay, with $650 for acute and $500 for psychiatric, while outpatient services have copays from $0 to $200. The plan covers primary care with no copay, and offers a range of other services with copays, including specialist visits, hearing and vision exams, and dental services. Preventive services and home health services are covered with no copay, while some services like ambulance and medical equipment have copays or coinsurance. Prescription hearing aids are covered with a maximum benefit of $350 per year. The plan also covers skilled nursing facility stays with varying copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $650 copay per admission or stay, and additional days are covered. For Inpatient Hospital Psychiatric, there is a $500 copay per admission or stay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Wellcare Advantage Premium Enhanced (PFFS) plan with a copay ranging from $0 to $200. Observation Services have a copay of $125 to $200. Ambulatory Surgical Center (ASC) Services have a $150 copay, while Outpatient Substance Abuse Services, including individual and group sessions, have no copay. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellcare Advantage Premium Enhanced (PFFS) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Advantage Premium Enhanced (PFFS) plan. Ground and air ambulance services have a $300 copay and no coinsurance, while 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 Advantage Premium Enhanced (PFFS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $35 copay, and all three have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Advantage Premium Enhanced (PFFS) plan covers primary care physician services with no copay, physician specialist services with a $20 copay, and physical therapy and speech-language pathology services with a $15 copay. Chiropractic services are covered with a $15 copay, while routine chiropractic care is not covered.
Preventive Services See details
The Wellcare Advantage Premium Enhanced (PFFS) plan covers an annual physical exam with no copay, as well as additional preventive services. Kidney Disease Education Services has a 20% coinsurance. Other preventive services include Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $350 per year, and prescription hearing aids (all types) have no copay, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Wellcare Advantage Premium Enhanced (PFFS) covers vision services, including eye exams with a copay of $0-$20 and eyewear with no copay. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The Wellcare Advantage Premium Enhanced (PFFS) plan covers dental services with a $20 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis, fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. Medicare Part B Insulin Drugs have a $35 copay, while 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 Advantage Premium Enhanced (PFFS) plan. You are responsible for 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Wellcare Advantage Premium Enhanced (PFFS) plan, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Wellcare Advantage Premium Enhanced (PFFS) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $200, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Advantage Premium Enhanced (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 under the Wellcare Advantage Premium Enhanced (PFFS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Advantage Premium Enhanced (PFFS) plan. There is no copay for days 1-20, a $203 copay for days 21-70, and no copay for days 71-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include a meal benefit with no copay, but acupuncture, over-the-counter items, and dual eligible SNPs with highly integrated services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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