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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 2025, 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 2025.
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 $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 Simple (PFFS).
Additional Benefits
The Wellcare Advantage Simple (PFFS) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services may have copays up to $300. Primary care, preventive services, and many vision and dental services are available with no copay. The plan covers ambulance and emergency services with copays, and home health services with no copay. Hearing exams, eyewear, and some medical equipment are covered. However, some services like cardiac rehabilitation and additional home care hours are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For acute care, you will pay a $350 copay for days 1-6, and no copay for days 7-90; for psychiatric care, the copay is $260 for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay of $0-$300, and observation services with a copay of $125-$300 per stay. Ambulatory Surgical Center (ASC) Services have a $250 copay, and outpatient substance abuse services, including individual and group sessions, have no copay. Outpatient Blood Services have no copay, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellcare Advantage Simple (PFFS) plan. You will pay a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellcare Advantage Simple (PFFS) plan. Medicare-covered 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 by the Wellcare Advantage Simple (PFFS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $35 copay, and all three have no coinsurance. Worldwide Urgent Coverage has a $125 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Wellcare Advantage Simple (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 no copay for individual and group sessions. The plan also covers other health care professionals with a copay between $0 and $20, psychiatric services with no copay for individual and group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $20 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services including Fitness Benefit, Remote Access Technologies, Alternative Therapies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services has a 20% coinsurance. Some preventive services, such as Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and more are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$20, and routine eye exams have no copay. Eyewear has no copay, and is covered up to a combined maximum of $100 every year for both in-network and out-of-network services.
Dental Services See details
Dental services include a $20 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Advantage Simple (PFFS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment (DME) with 20% coinsurance, and prosthetic devices and medical supplies with 20% coinsurance. Diabetic equipment is covered with a coinsurance for Medicare-covered diabetic supplies, and a copay for Medicare-covered diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellcare Advantage Simple (PFFS) plan. Diagnostic Procedures/Tests have no copay, and Lab Services have no copay. Diagnostic Radiological Services may have a copay of at most $280.00, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Wellcare Advantage Simple (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 Advantage Simple (PFFS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellcare Advantage Simple (PFFS) plan. There is no copay for days 1-20, a $214 copay for days 21-60, and no copay for days 61-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes a meal benefit with no copay, but does not cover acupuncture, over-the-counter items, or dual eligible SNPs with highly integrated services.
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