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Wellcare Advantage Simple (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Advantage Simple (PFFS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Advantage Simple (PFFS) in 2026, please refer to our full plan details page.
Wellcare Advantage Simple (PFFS) is a PFFS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in ME. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Wellcare Advantage Simple (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 Simple (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 Simple (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:
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Drug Coverage
Prescription drugs are not covered by Wellcare Advantage Simple (PFFS).
Additional Benefits
The Wellcare Advantage Simple (PFFS) plan offers robust medical coverage with affordable cost-sharing, including no copays for primary care, preventive services, and home health care. For specialized care, members pay a low $20 copay for specialists and up to $300 for outpatient services, with no coinsurance required. Inpatient hospital stays are covered with a daily copay for the first six days of a stay, after which there is no copay. Additionally, the plan provides routine dental, vision, and hearing exams with no copays, along with annual allowances for dental services, eyewear, and hearing aids. Urgent and emergency care are covered under flat copays with no coinsurance, while durable medical equipment and dialysis services require a 20% coinsurance and no copay. Skilled nursing facility care is also available, featuring no copay for the first 20 days of treatment.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Wellcare Advantage Simple (PFFS) with no coinsurance, requiring a $350 daily copay for days 1 through 6 of acute stays and a $260 daily copay for days 1 through 6 of psychiatric stays, with no copay for days 7 through 90. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Wellcare Advantage Simple (PFFS) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $300 for outpatient hospital services and $130 to $300 per stay for observation services. Ambulatory surgical center services require a $250 copay with no coinsurance, while outpatient substance abuse and blood services are covered with no copays or coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the Wellcare Advantage Simple (PFFS) plan with a $140.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Wellcare Advantage Simple (PFFS) covers Medicare-approved ground and air ambulance services with a $300 copay and no coinsurance, and this copayment is not waived upon hospital admission. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Advantage Simple (PFFS) covers emergency services with a $130 copay and no coinsurance, and urgent care with a $35 copay and no coinsurance, with copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum benefit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Advantage Simple (PFFS) covers primary care, mental health, and psychiatric services with no copay and no coinsurance, while specialist, physical therapy, occupational therapy, and opioid treatment services require a $20 copay and no coinsurance. Telehealth has a $0 to $35 copay and no coinsurance, but podiatry is not covered, and chiropractic services are only partially covered with a $15 copay and no coinsurance, as routine and other chiropractic services are excluded.
Preventive Services See details
Wellcare Advantage Simple (PFFS) covers preventive services, offering annual physical exams, fitness benefits, alternative therapies, and select screenings with no copay and no coinsurance, while kidney disease education requires no copay and a 20% coinsurance. Additional preventive benefits are partially covered, excluding Medicare-covered zero dollar preventive services, health education, in-home safety assessments, PERS, medical nutrition therapy, and in-home support.
Hearing Services See details
Hearing services are covered by Wellcare Advantage Simple (PFFS), featuring a $20 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though OTC, inner-ear, outer-ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Wellcare Advantage Simple (PFFS) provides partially covered vision services, which include one routine eye exam per year with no copay and no coinsurance, while other eye exam services are not covered. Eyewear, including contacts, eyeglasses, and upgrades, is covered with no copay and no coinsurance up to a combined maximum benefit of $100 per year.
Dental Services See details
Wellcare Advantage Simple (PFFS) provides partially covered dental services with a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive benefits up to a $1,000 annual limit. Prosthodontics (fixed and removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Wellcare Advantage Simple (PFFS) with no copay, while associated Medicare Part B chemotherapy and other drugs carry a coinsurance of 0% to 20%. Covered Medicare Part B insulin is available for a $35 copay and no coinsurance, and step therapy may apply.
Dialysis Services See details
Dialysis Services are covered by Wellcare Advantage Simple (PFFS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment covered by Wellcare Advantage Simple (PFFS) includes durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are available with no copay from specified manufacturers, while diabetic therapeutic shoes and inserts require a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Wellcare Advantage Simple (PFFS) covers diagnostic and radiological services with no copay and no coinsurance for lab services, diagnostic procedures, and diagnostic radiological services. Outpatient X-rays require a $15 copay, while therapeutic radiological services are covered with a 20% coinsurance.
Home Health Services See details
Wellcare Advantage Simple (PFFS) covers Home Health Services with no copay and no coinsurance. This benefit ensures eligible members can receive essential in-home medical care at no additional cost.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Wellcare Advantage Simple (PFFS) with no coinsurance, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Advantage Simple (PFFS) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day inpatient hospital stay requirement. There is no copay for days 1 to 20 and days 61 to 100, a $218 copay for days 21 to 60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellcare Advantage Simple (PFFS) partially covers other services, providing a meal benefit for chronic illness with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other miscellaneous services are not covered under this benefit.
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