Wellcare Premium Enhanced (PFFS)

WellCare Health Plans, Inc.
Wellcare Premium Enhanced (PFFS) H2816-019 Plan Details
3.5 out of 5 stars

Wellcare Premium Enhanced (PFFS) is a PFFS Medicare Advantage (Medicare Part C) plan offered by WellCare Health Plans, Inc..
Plan ID: H2816-019.

$55.00
Monthly Premium

Wellcare Premium Enhanced (PFFS) is a PFFS Medicare Advantage (Medicare Part C) plan offered by WellCare Health Plans, Inc..
Plan ID: H2816-019.

WellCare Health Plans, Inc.
Wellcare Premium Enhanced (PFFS) H2816-019 Plan Details
3.5 out of 5 stars

Wellcare Premium Enhanced (PFFS) is a PFFS Medicare Advantage (Medicare Part C) plan offered by WellCare Health Plans, Inc..
Plan ID: H2816-019.

$55.00
Monthly Premium

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $-1
Out-of-Network: 3400
Initial Coverage Limit $4430
Catastrophic Coverage Limit $7,050
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 additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
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 Eqipment (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
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $300.00

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per stay $120.00 to $300.00

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $250.00
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 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 from in-network providers.

Coverage Cost
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 from in-network providers.

Coverage Cost
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 from in-network providers.

Coverage Cost
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 from in-network providers.

Coverage Cost
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.