Wellcare Advantage No Premium (PFFS)
H2816 - 040 - 0
(3 / 5)
Wellcare Advantage No Premium (PFFS) is a Medicare Advantage (Part C) Plan by Wellcare.
This page features plan details for 2023 Wellcare Advantage No Premium (PFFS) H2816 – 040 – 0 available in Select counties in ME.
IMPORTANT: This page has been updated with plan and premium data for 2023.
Locations
Wellcare Advantage No Premium (PFFS) is offered in the following locations.
Plan Overview
Wellcare Advantage No Premium (PFFS) offers the following coverage and cost-sharing.
| Insurer: | Wellcare |
| Health Plan Deductible: | $0.00 |
| MOOP: | $6,700 In and Out-of-network |
| Drugs Covered: | No |
Ready to sign up for Wellcare Advantage No Premium (PFFS) ?
Get help from a licensed insurance agent.
Click to Call 1-877-354-4611 TTY 711.
Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.
Premium Breakdown
Wellcare Advantage No Premium (PFFS) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $164.90 | $0.00 | $0.00 | $164.90 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Wellcare Advantage No Premium (PFFS) also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: No |
Dental (comprehensive)
| Diagnostic services: | Not covered (no limits) |
| Endodontics: | Not covered (no limits) |
| Extractions: | Not covered (no limits) |
| Non-routine services: | Not covered (no limits) |
| Periodontics: | Not covered (no limits) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered (no limits) |
| Restorative services: | Not covered (no limits) |
Dental (preventive)
| Cleaning: | Not covered (no limits) |
| Dental x-ray(s): | Not covered (no limits) |
| Fluoride treatment: | Not covered (no limits) |
| Oral exam: | Not covered (no limits) |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | In-Network: $0-250 copay |
| Diagnostic radiology services (e.g., MRI): | Out-of-Network: 30% coinsurance |
| Diagnostic tests and procedures: | In-Network: $0 copay |
| Diagnostic tests and procedures: | Out-of-Network: 30% coinsurance |
| Lab services: | In-Network: $0 copay |
| Lab services: | Out-of-Network: 30% coinsurance |
| Outpatient x-rays: | In-Network: $0 copay |
| Outpatient x-rays: | Out-of-Network: 30% coinsurance |
Doctor visits
| Primary: | In-Network: $10 copay per visit |
| Primary: | Out-of-Network: $20 copay per visit |
| Specialist: | In-Network: $35 copay per visit |
| Specialist: | Out-of-Network: $50 copay per visit |
Emergency care/Urgent care
| Emergency: | $95 copay per visit (always covered) |
| Urgent care: | $35 copay per visit (always covered) |
Foot care (podiatry services)
| Foot exams and treatment: | In-Network: $35 copay |
| Foot exams and treatment: | Out-of-Network: $50 copay |
| Routine foot care: | Not covered |
Ground ambulance
| In-Network: $300 copay | |
| Out-of-Network: $300 copay |
Health plan deductible
| $0.00 |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | In-Network: $0 copay (limits may apply) |
| Fitting/evaluation: | Out-of-Network: 40% coinsurance (limits may apply) |
| Hearing aids – inner ear: | Not covered (no limits) |
| Hearing aids – outer ear: | Not covered (no limits) |
| Hearing aids – over the ear: | Not covered (no limits) |
| Hearing exam: | In-Network: $35 copay |
| Hearing exam: | Out-of-Network: $50 copay |
Hospital coverage (inpatient)
| In-Network: $300 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 91 and beyond | |
| Out-of-Network: $350 per day for days 1 through 7 $0 per day for days 8 and beyond |
Hospital coverage (outpatient)
| In-Network: $250-300 copay per visit | |
| Out-of-Network: 30% coinsurance per visit |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $6,700 In and Out-of-network |
Medical equipment/supplies
| Diabetes supplies: | In-Network: $0 copay per item |
| Diabetes supplies: | Out-of-Network: 20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen): | In-Network: 20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen): | Out-of-Network: 20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs): | In-Network: 20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs): | Out-of-Network: 20% coinsurance per item |
Medicare Part B drugs
| Chemotherapy: | In-Network: 20% coinsurance |
| Chemotherapy: | Out-of-Network: 30% coinsurance |
| Other Part B drugs: | In-Network: 20% coinsurance |
| Other Part B drugs: | Out-of-Network: 30% coinsurance |
Mental health services
| Inpatient hospital – psychiatric: | In-Network: $260 per day for days 1 through 6 $0 per day for days 7 through 90 |
| Inpatient hospital – psychiatric: | Out-of-Network: $300 per day for days 1 through 7 $0 per day for days 8 through 90 |
| Outpatient group therapy visit: | In-Network: $25 copay |
| Outpatient group therapy visit: | Out-of-Network: 30% coinsurance |
| Outpatient group therapy visit with a psychiatrist: | In-Network: $25 copay |
| Outpatient group therapy visit with a psychiatrist: | Out-of-Network: 30% coinsurance |
| Outpatient individual therapy visit: | In-Network: $25 copay |
| Outpatient individual therapy visit: | Out-of-Network: 30% coinsurance |
| Outpatient individual therapy visit with a psychiatrist: | In-Network: $25 copay |
| Outpatient individual therapy visit with a psychiatrist: | Out-of-Network: 30% coinsurance |
Optional supplemental benefits
| No |
Preventive care
| In-Network: $0 copay | |
| Out-of-Network: $0 copay |
Rehabilitation services
| Occupational therapy visit: | In-Network: $35 copay |
| Occupational therapy visit: | Out-of-Network: 30% coinsurance |
| Physical therapy and speech and language therapy visit: | In-Network: $35 copay |
| Physical therapy and speech and language therapy visit: | Out-of-Network: 30% coinsurance |
Skilled Nursing Facility
| In-Network: $0 per day for days 1 through 20 $196 per day for days 21 through 60 $0 per day for days 61 through 100 | |
| Out-of-Network: $0 per day for days 1 through 20 $196 per day for days 21 through 100 |
Transportation
| Not covered |
Vision
| Contact lenses: | Not covered (no limits) |
| Eyeglass frames: | Not covered (no limits) |
| Eyeglass lenses: | Not covered (no limits) |
| Eyeglasses (frames and lenses): | Not covered (no limits) |
| Other: | Not covered (no limits) |
| Routine eye exam: | In-Network: $0 copay (limits may apply) |
| Routine eye exam: | Out-of-Network: 40% coinsurance (limits may apply) |
| Upgrades: | Not covered |
Wellness programs (e.g., fitness, nursing hotline)
| Covered |
Ready to sign up for Wellcare Advantage No Premium (PFFS) ?
Get help from a licensed insurance agent.
Click to Call 1-877-354-4611 TTY 711.
Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.