Wellcare Advantage Simple (PFFS) Medicare Advantage Plan H2816-038 • 2026 • Erie County, NY

Wellcare Advantage Simple Overview

Coverage Overview for Wellcare Advantage Simple

With a monthly premium of $0.00, this Private Fee-for-Service Medicare Advantage plan covers Medicare Part A and Part B services and allows access to Medicare-approved providers who agree to the plan’s terms. Referrals are not required, and provider participation is determined at the time services are received.

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 $35 copay, and ambulance transportation is $335 copay | Out-of-network: $335 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6700.00. After this limit is reached, covered services are fully paid.

This plan is listed by CMS under Plan ID H2816-038. A breakdown of cost sharing is provided below.

Out-of-Pocket Costs

Wellcare Advantage Simple 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 H2816-038.

Certain preventive services are covered 100% by Wellcare Advantage Simple as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

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.