A non-government entity
Wellcare Advantage Enhanced (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Advantage 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 Enhanced (PFFS) in 2026, please refer to our full plan details page.
Wellcare Advantage 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 Advantage 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 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 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 $4300.00 (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 $4300.00 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 Advantage Enhanced (PFFS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by Wellcare Advantage Enhanced (PFFS).
Additional Benefits
The Wellcare Advantage Enhanced (PFFS) Medicare plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for primary care, mental health visits, or home health services. Inpatient hospital stays require a $500 copay per admission with no coinsurance, while specialist visits require a $20 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted within 24 hours, and urgent care is available with a $35 copay. Additionally, this plan provides strong supplemental coverage, including routine dental care with no copay up to a $2,000 annual limit and routine vision exams with a $200 annual allowance for eyewear. Diagnostic tests, lab services, and routine hearing exams are also covered with no copay or coinsurance. Durable medical equipment, prosthetics, and dialysis services are available with no copay and a 20% coinsurance.
Inpatient Hospital See details
Wellcare Advantage Enhanced (PFFS) covers inpatient acute and psychiatric hospital stays with a $500 copay per admission and no coinsurance. Unlimited additional days for acute stays are covered with no copay, though additional psychiatric days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Wellcare Advantage Enhanced (PFFS) covers outpatient services with no coinsurance, featuring outpatient hospital copays of $0 to $200 and observation stay copays of $130 to $200. Ambulatory surgical center services require a $150 copay with no coinsurance, while outpatient substance abuse and blood services are provided with no copays and no coinsurance.
Partial Hospitalization See details
Wellcare Advantage Enhanced (PFFS) covers partial hospitalization benefits with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Wellcare Advantage Enhanced (PFFS) covers ground and air ambulance services with a $300 copay and no coinsurance. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
Wellcare Advantage Enhanced (PFFS) covers emergency services with a $130 copay and no coinsurance, and urgent care with a $35 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered with a $130 copay, no coinsurance, and a $50,000 maximum benefit limit, though worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Advantage Enhanced (PFFS) covers primary care, mental health, and psychiatric services with no copay and no coinsurance. Specialist visits require a $20 copay and physical, occupational, and speech therapies require a $15 copay, both with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the Wellcare Advantage Enhanced (PFFS) plan, offering an annual physical exam, fitness benefits, remote access technologies, alternative therapies, and select screenings with no copay and no coinsurance. Kidney disease education is also covered with no copay and a 20% coinsurance, though Medicare-covered zero-dollar preventive services and various supplemental options like health education and nutritional therapy are not covered.
Hearing Services See details
Wellcare Advantage Enhanced (PFFS) covers Medicare-covered hearing exams with a $20 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a maximum of $500 per ear annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Advantage Enhanced (PFFS) provides partially covered vision services with no deductibles and no coinsurance, though other eye exam services are not covered. Routine eye exams are covered with no copay for one visit per year, and eyewear is covered with no copay up to a combined maximum benefit of $200 annually.
Dental Services See details
Wellcare Advantage Enhanced (PFFS) offers Medicare-covered dental services for a $20 copay and no coinsurance, while other dental benefits are partially covered with no copay and no coinsurance up to a $2,000 annual limit. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Advantage Enhanced (PFFS) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance. Part B insulin is also covered under this benefit with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Wellcare Advantage Enhanced (PFFS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Advantage Enhanced (PFFS) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay from specified manufacturers, while diabetic therapeutic shoes and inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellcare Advantage Enhanced (PFFS) covers diagnostic and radiological services, offering diagnostic tests, lab services, diagnostic radiology, and outpatient X-rays with no copay and no coinsurance. Therapeutic radiological services are covered with a 20% coinsurance.
Home Health Services See details
Wellcare Advantage Enhanced (PFFS) covers home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Wellcare Advantage Enhanced (PFFS) offers Cardiac Rehabilitation Services with no coinsurance, meaning some services are covered; however, standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for PAD ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Advantage Enhanced (PFFS) covers skilled nursing facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and days 61 through 100, and a $218 daily copay for days 21 through 60. Prior hospital stays of three days are not required for admission, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Wellcare Advantage Enhanced (PFFS) partially covers other services, providing a chronic illness meal benefit with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other additional services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved