Wellcare Advantage Enhanced (PFFS) Medicare Advantage Plan H2816-037 • 2026 • Schoharie County, NY

Wellcare Advantage Enhanced Overview

Plan Overview for Wellcare Advantage Enhanced

This Medicare Advantage Private Fee-for-Service (PFFS) plan allows access to Medicare-approved providers who agree to the plan’s terms. The monthly premium is $0.00, and the plan includes Medicare Part A and Part B benefits with fewer network restrictions.

Primary care visits have a $0 copay | Out-of-network: $10 copay, specialist visits come with a $20 copay | Out-of-network: $35 copay, urgent care services carry a $35 copay, and ambulance transportation is $300 copay | Out-of-network: $300 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $4300.00. After this limit is reached, covered services are fully paid for the remainder of the year.

This plan is registered with CMS under Plan ID H2816-037. Cost-sharing details for key services are provided below.

Cost Sharing Expenses

Wellcare Advantage Enhanced has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H2816-037.

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

Prescription Drug Coverage

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

CMS Star Ratings

The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.