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FHCP Medicare Rx Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for FHCP Medicare Rx Plus (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on FHCP Medicare Rx Plus (HMO-POS) in 2026, please refer to our full plan details page.
FHCP Medicare Rx Plus (HMO-POS) is a HMO-POS plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Counties: BRE, FLA, SEM, SJO and VOL. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that FHCP Medicare Rx Plus (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about FHCP Medicare Rx Plus (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For FHCP Medicare Rx Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The FHCP Medicare Rx Plus (HMO-POS) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will enjoy no copay when using a preferred pharmacy or standard mail order for multi-month supplies. Additionally, Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies. Tier 3 preferred brand drugs require a copayment starting at $42 at preferred pharmacies and $47 at standard pharmacies for a one-month supply. For higher-tier medications, including Tier 4 non-preferred drugs and Tier 5 specialty drugs, you will pay a 25% coinsurance at both preferred and standard pharmacies.
Additional Benefits
The FHCP Medicare Rx Plus (HMO-POS) plan offers robust core medical coverage with no copay for primary care visits and an $8 to $40 copay for specialist consultations. Inpatient hospital stays require a $350 daily copay for days 1 through 6 followed by no copay, while outpatient hospital visits also carry a $350 copay. Additionally, emergency services require a $130 copay, which is waived if you are admitted, and urgent care visits range from no copay to a $40 copay. For ancillary care, routine hearing and vision services are highly accessible, featuring no copay for annual hearing exams and a $15 copay for routine eye exams. Home health care, preventive services, and laboratory tests are all covered with no copay, while medical equipment and dialysis services require a 20% coinsurance. Skilled nursing facility care is also available with no copay for the first 20 days, and Medicare-covered dental services carry a $40 copay.
Inpatient Hospital See details
Inpatient hospital services are covered by FHCP Medicare Rx Plus (HMO-POS) with no coinsurance, requiring a $350 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, while unlimited additional acute care days are covered with no copay.
Outpatient Services See details
FHCP Medicare Rx Plus (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital and observation services for a $350 copay and ambulatory surgical center services for a $275 copay. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by FHCP Medicare Rx Plus (HMO-POS) with a $100.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by FHCP Medicare Rx Plus (HMO-POS), featuring a $175 copay for ground ambulance services and a 20% coinsurance for air ambulance services, with prior authorization required. Although transportation services are technically covered, trips to plan-approved or any other health-related locations are not covered in practice.
Emergency Services See details
FHCP Medicare Rx Plus (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require no copay to a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $25,000 maximum with copays ranging from $40 to $175 and no coinsurance.
Primary Care See details
FHCP Medicare Rx Plus (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits require an $8 to $40 copay and no coinsurance. Physical, occupational, and speech therapies have a $25 copay, mental health services have a $40 copay, and telehealth ranges from no copay to a $30 copay, all with no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
FHCP Medicare Rx Plus (HMO-POS) offers partially covered preventive services with no copay and no coinsurance for all covered benefits, including Medicare-covered zero-dollar preventive services, health education, memory fitness, and glaucoma screenings. However, certain sub-services are not covered, including annual physical exams, medical nutrition therapy, weight management programs, and in-home safety assessments.
Hearing Services See details
FHCP Medicare Rx Plus (HMO-POS) covers Medicare-covered hearing exams with a $45 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay or coinsurance. Hearing aids are partially covered with a $300 annual maximum benefit per ear and no copay or coinsurance, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
FHCP Medicare Rx Plus (HMO-POS) provides partially covered vision services with no deductibles and no coinsurance. Routine eye exams are covered with a $15 copay once per year, and complete eyeglasses (lenses and frames) are covered with no copay up to a $90 maximum every two years, whereas other eye exams, contact lenses, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by FHCP Medicare Rx Plus (HMO-POS), offering coverage only for Medicare-covered dental services with a $40 copay and no coinsurance, subject to prior authorization and referral requirements. Preventive and comprehensive dental services, including cleanings, exams, x-rays, restorative care, and orthodontics, are not covered.
Home Infusion bundled Services See details
FHCP Medicare Rx Plus (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, insulin, and other drugs carry a coinsurance ranging from no coinsurance to 20% coinsurance, with Part B insulin drugs also requiring a $35 copay.
Dialysis Services See details
FHCP Medicare Rx Plus (HMO-POS) covers dialysis services with no copay and a 20% coinsurance, though a referral is required.
Medical Equipment See details
FHCP Medicare Rx Plus (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic services, with no copay and 20% coinsurance (ranging from no coinsurance to 20% for diabetic supplies). Prior authorization is required for these benefits, and certain items may be restricted to preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by FHCP Medicare Rx Plus (HMO-POS), requiring prior authorization and referrals. Lab services have no copay or coinsurance, diagnostic tests carry a $0 to $350 copay with no coinsurance, outpatient X-rays require a $10 copay, and therapeutic radiology has a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by FHCP Medicare Rx Plus (HMO-POS) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no coinsurance under FHCP Medicare Rx Plus (HMO-POS), although prior authorization and referrals are required. However, specific programs including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by FHCP Medicare Rx Plus (HMO-POS) with no coinsurance, requiring prior authorization and a referral but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the FHCP Medicare Rx Plus (HMO-POS) plan, which does not provide coverage for acupuncture, over-the-counter (OTC) items, or meal benefits.
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