Wellcare Premium Enhanced (PFFS)
Wellcare Premium Enhanced (PFFS) is a PFFS Medicare Advantage (Medicare Part C) plan offered by WellCare Health Plans, Inc.
Plan ID: H2816-019-000
New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.
Learn more about New York Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $55.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $0.00 |
| Out-of-pocket maximum | ($1.00) |
| Initial drug coverage limit | $4,430.00 |
| Catastrophic drug coverage limit | $7,050.00 |
| Primary care doctor visit | $10 Out-of-Network $25 |
| Specialty doctor visit | $35 Out-of-Network $60 |
| Inpatient hospital care | $295 copay per day for days 1-5 and a $0 copay per day for days 6-90 Out-of-Network $300 copay per day for days 1-7 and a $0 copay per day for days 8-90 |
| Urgent care | $35 Out-of-Network $35 |
| Emergency room visit | $120 Out-of-Network $120 |
| Ambulance transportation | $350 Out-of-Network $350 |
Health Care Services and Medical Supplies
Wellcare Premium Enhanced (PFFS) covers a range of additional benefits. Learn more about Wellcare Premium Enhanced (PFFS) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
| Coverage | Details |
|---|---|
| Chiropractic services | Medicare Covered Chiropractic Services: $20 per visit Out-of-Network Medicare Covered Chiropractic Services: 30% per visit |
| Diabetes supplies, training, nutrition therapy and monitoring | Diabetes Supplies: $0 / Diabetes Self-Management Training: $0 / Diabetic Therapeutic Shoes or Inserts: 20% Out-of-Network Diabetes Supplies: 30% / Diabetes Self-Management Training: $0 / Diabetic Therapeutic Shoes or Inserts: 30% |
| Durable medical equipment (DME) | 20% Out-of-Network 30% |
| Diagnostic tests, lab and radiology services, and X-rays | X-Ray Services: $0 / Lab Services: $0. $0 for COVID-related testing. For other services, please refer to the Evidence of Coverage for more information. Out-of-Network X-Ray Services: 30% / Lab Services: 30%. $0 for COVID-related testing. For other services, please refer to the Evidence of Coverage for more information. |
| Home health care | $0 copay Out-of-Network 30% |
| Mental health inpatient care | $295 copay per day for days 1-5 and a $0 copay per day for days 6-90 Out-of-Network $300 copay per day for days 1-7 and a $0 copay per day for days 8-90 |
| Mental health outpatient care | $25 for individual or group Out-of-Network 30% for individual or group |
| Outpatient services/surgery | Out-of-Network: Outpatient Hospital and ASC Services: Coinsurance for Medicare Covered Outpatient Hospital Services 30% Coinsurance for Medicare Covered Ambulatory Surgical Center Services 30% |
| Outpatient substance abuse care | $25 for individual or group Out-of-Network 30% for individual or group |
| Podiatry services | Medicare Covered Podiatry Services: $35 Out-of-Network Medicare Covered Podiatry Services: $60 |
| Skilled Nursing Facility (SNF) care | $0 copay per day for days 1-20 and a $165 copay per day for days 21-100 Out-of-Network $0 copay per day for days 1-20 and a $250 copay per day for days 21-100 |
Dental Benefits
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Dental care | This plan does not offer supplemental dental coverage. Out-of-Network This plan does not offer supplemental dental coverage. |
Vision Benefits
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Vision benefits | The vision benefits on this plan cover Routine Eye exams only Out-of-Network The vision benefits on this plan cover Routine Eye exams only with a 40% coinsurance OON |
Hearing Benefits
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing benefits | The hearing benefits on this plan cover Routine hearing exams only Out-of-Network The hearing benefits on this plan cover Routine hearing exams only with a 40% coinsurance OON |
Preventive Services and Health/Wellness Education Programs
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | Most services offered at $0 cost share, please refer to your Evidence of Coverage for more information. Out-of-Network Most services offered at $0 cost share, please refer to your Evidence of Coverage for more information. |
When reviewing New York Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of New York that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
| Links to plan documents |
New York Counties Served
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
