2022 Wellcare Advantage Premium Enhanced (PFFS)

Wellcare Advantage Premium Enhanced (PFFS) H2816-037 is a 2022 Medicare Advantage Plan or Part-C by Wellcare available to residents in New York. This plan does not provide additional prescription drug (Part-D) coverage. The Wellcare Advantage Premium Enhanced (PFFS) has a monthly premium of $62.00 and has an in-network maximum out-of-pocket limit of $- (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $- out-of-pocket. This can be a extremely nice safety net.

Wellcare Advantage Premium Enhanced (PFFS) is a PFFS *. A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan offered by a contract with the Centers for Medicare & Medicaid Services (CMS) to provide you with benefits. Wellcare (instead of Medicare) will decide on how much it will cover and how much you will pay for the services you get. You may go to any Medicare approved doctor or hospital or any other health care provider that accepts both Medicare and your plans payment. A PFFS plan has no provider network, and you dont need a referral or a primary care physician for any health care or services. PFFS plans are the most flexible but a doctor will make a visit-by-visit decisions on whether to accept your provider.

Wellcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Wellcare Advantage Premium Enhanced (PFFS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Wellcare and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Wellcare except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Wellcare Medicare Advantage Plan Costs

2021 Wellcare Advantage Premium Enhanced (PFFS) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	Not covered

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$0-200 copay
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0 copay
Lab services	30% coinsurance (Out-of-Network)
Lab services	$0 copay
Outpatient x-rays	$0 copay
Outpatient x-rays	30% coinsurance (Out-of-Network)

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Doctor Visits

Primary	$10 copay per visit (Out-of-Network)
Primary	$0 copay
Specialist	$35 copay per visit (Out-of-Network)
Specialist	$25 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$35 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$25 copay
Foot exams and treatment	$35 copay (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$300 copay (Out-of-Network)
$300 copay

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Hearing

Fitting/evaluation	40% coinsurance (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids - inner ear	Not covered
Hearing aids - outer ear	Not covered
Hearing aids - over the ear	Not covered
Hearing exam	$35 copay (Out-of-Network)
Hearing exam	$25 copay

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Inpatient Hospital Coverage

$388 per day for days 1 through 7 $0 per day for days 8 and beyond (Out-of-Network)
$650 per stay

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Medical Equipment/Supplies

Diabetes supplies	$0 copay per item
Diabetes supplies	30% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	30% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$500 per stay
Inpatient hospital - psychiatric	$300 per day for days 1 through 7 $0 per day for days 8 through 90 (Out-of-Network)
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)

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MOOP

$6,700 In and Out-of-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

30% coinsurance per visit (Out-of-Network)
$200 copay per visit

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Preventive Care

$0 copay
$0 copay (Out-of-Network)

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Preventive Dental

Cleaning	Not covered
Dental x-ray(s)	Not covered
Fluoride treatment	Not covered
Oral exam	Not covered

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Rehabilitation Services

Occupational therapy visit	30% coinsurance (Out-of-Network)
Occupational therapy visit	$15 copay
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$15 copay

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Skilled Nursing Facility

$0 per day for days 1 through 20 $200 per day for days 21 through 100 (Out-of-Network)
$0 per day for days 1 through 20 $150 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	Not covered
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	40% coinsurance (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Wellcare Advantage Premium Enhanced (PFFS) H2816

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Wellcare Advantage Premium Enhanced (PFFS) Plans Performance

Health Plan Customer Service Rating for Wellcare Advantage Premium Enhanced (PFFS)

Wellcare Advantage Premium Enhanced (PFFS) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Wellcare Advantage Premium Enhanced (PFFS)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.