Wellcare Premium Enhanced (PFFS) Medicare Advantage Plan H2816-019 • 2026 • Erie County, NY

Wellcare Premium Enhanced Overview

Coverage Overview for Wellcare Premium Enhanced

This MAPD Private Fee-for-Service (PFFS) plan includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $50.00, and the plan allows access to Medicare-approved providers who accept the plan’s payment terms. Referrals are not required, and provider participation is determined at the time services are received. The annual Part D deductible is $615.00.

Primary care visits have a $0 copay | Out-of-network: $25 copay, specialist visits come with a $20 copay | Out-of-network: $45 copay, urgent care services carry a $40 copay, and ambulance transportation is $350 copay | Out-of-network: $350 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $3400.00. After this limit is reached, covered services are fully paid.

This plan is listed by CMS under Plan ID H2816-019. A summary of cost sharing is provided below.

Out-of-Pocket Costs

Wellcare Premium Enhanced includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H2816-019.

Certain preventive services are covered 100% by Wellcare Premium Enhanced as a Part B benefit.

Prescription Drug Coverage

Wellcare Premium Enhanced includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $615.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Wellcare starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Wellcare Premium Enhanced may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

CMS 5-Star Ratings

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.