Wellcare Advantage Simple (PFFS)

by Wellcare

2026 Medicare Advantage plan available in Maine

Plan ID H2816-040-0

Additional coverage:

HearingVisionDental

Medicare Advantage PFFS $0 premium 3.5 Overall

Monthly plan premium $0 / mo

Annual deductible $0 / yr

Max out-of-pocket · in-network $4,300 In and Out-of-network / yr

3.5 Overall Government Star Rating 2026 · out of 5 stars

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Plan Overview

Wellcare Advantage Simple (PFFS) is a Medicare Advantage Plan Without Prescription Drugs, which is available in Maine and offered by the health insurance company Wellcare. This plan's network type is PFFS, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name Wellcare Advantage Simple (PFFS)

Insurance Carrier Wellcare

Plan Type Medicare Advantage Plan Without Prescription Drugs

Network Type PFFS

Cost Summary

Wellcare Advantage Simple (PFFS) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $4,300 In and Out-of-network. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $0 / mo

Annual Deductible $0 / yr

Max Out-of-Pocket · in-network $4,300 In and Out-of-network / yr

Primary doctor visit $0 copay

Specialist visit $20 copay

ER visit $130 copay

Ambulance $300 copay

Additional Benefits and Coverage

Wellcare Advantage Simple (PFFS) is a Medicare Advantage plan which does not include Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Wellcare Advantage Simple (PFFS) includes coverage for hearing, vision, dental.

Part D Prescription Drug Coverage No

Dental Yes

Vision Yes

Hearing Yes

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Not covered

In-home support services Not covered

Home & bathroom safety devices Not covered

Meals for short duration Limited coverage

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: $0 copay
Out-of-network: $25 copay

Specialist visit In-network: $20 copay
Out-of-network: $45 copay

Tests, labs & imaging

Diagnostic tests & procedures In-network: $0 copay
Out-of-network: 30% coinsurance

Lab services In-network: $0-$50 copay
Out-of-network: 30% coinsurance

Diagnostic radiology services (like MRI) In-network: $0-$250 copay
Out-of-network: 30% coinsurance

Outpatient x-rays In-network: $15 copay
Out-of-network: 30% coinsurance

Emergency care $130 copay

Urgent care $35 copay

Hospital Services

Inpatient hospital coverage In-network:
  Tier 1
  $350 per day for days 1-6
  $0 per day for days 7-90
  $0 per stay
Out-of-network:
  30% per day for days 1-90
  0% per stay

Outpatient hospital coverage In-network: $0-$300 copay
Out-of-network: 30% coinsurance

Skilled nursing facility

Skilled nursing facility In-network:
  Tier 1
  $0 per day for days 1-20
  $218 per day for days 21-60
  $0 per day for days 61-100
Out-of-network:
  30% per day for days 1-100
  0% per stay

Preventive services

Preventive services In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance In-network: $300 copay
Out-of-network: $300 copay

Therapy services

Occupational therapy visit In-network: $20 copay
Out-of-network: 30% coinsurance

Physical therapy & speech & language therapy visit In-network: $20 copay
Out-of-network: 30% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist In-network: $0 copay
Out-of-network: 30% coinsurance

Outpatient individual therapy with a psychiatrist In-network: $0 copay
Out-of-network: 30% coinsurance

Outpatient group therapy visit In-network: $0 copay
Out-of-network: 30% coinsurance

Outpatient individual therapy visit In-network: $0 copay
Out-of-network: 30% coinsurance

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Diabetes supplies In-network: $0 copay
Out-of-network: 30% coinsurance

Medicare star rating

Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Wellcare Advantage Simple (PFFS) earned an overall rating of 3.5 stars — worse than Maine's state average of 3.8 stars.

Rating category This plan State average

Overall star rating ★ 3.5 3.8

Health plan quality

Summary rating of health plan quality ★ 3.0 3.6

Staying healthy: screenings, tests & vaccines ★ 3.0 3.6

Managing chronic (long-term) conditions ★ 2.0 3.1

Member experience with health plan ★ 4.0 3.4

Member complaints & changes in performance ★ 4.0 4.2

Health plan customer service – 4.0

Extra Benefits

Hearing

Hearing exam In-network: $0 copay
Out-of-network: 40% coinsurance

Fitting/evaluation In-network: $0 copay
Out-of-network: 40% coinsurance

Hearing aids - prescription In-network: $0 copay
Out-of-network: 40% coinsurance

Hearing aids - over the counter Not covered

Preventive dental

Oral exam In-network: $0 copay
Out-of-network: 50% coinsurance

Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance

Fluoride treatment In-network: $0 copay
Out-of-network: 50% coinsurance

Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance

Comprehensive dental

Restorative services In-network: $0 copay
Out-of-network: 50% coinsurance

Endodontics In-network: $0 copay
Out-of-network: 50% coinsurance

Periodontics In-network: $0 copay
Out-of-network: 50% coinsurance

Prosthodontics, removable Not covered

Prosthodontics, fixed Not covered

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery In-network: $0 copay
Out-of-network: 50% coinsurance

Orthodontics Not covered

Adjunctive general services In-network: $0 copay
Out-of-network: 50% coinsurance

Vision

Routine eye exam In-network: $0 copay
Out-of-network: 40% coinsurance

Contact lenses In-network: $0 copay
Out-of-network: 40% coinsurance

Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: 40% coinsurance

Eyeglass frames (only) In-network: $0 copay
Out-of-network: 40% coinsurance

Eyeglass lenses (only) In-network: $0 copay
Out-of-network: 40% coinsurance

Upgrades In-network: $0 copay
Out-of-network: 40% coinsurance

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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