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Wellpoint Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Medicare Advantage (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint Medicare Advantage (HMO-POS) in 2026, please refer to our full plan details page.
Wellpoint Medicare Advantage (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2026 to people living in Select Counties in West Virginia. The overall rating for this plan is not yet available for 2026.
It's important to know that Wellpoint Medicare Advantage (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 Wellpoint Medicare Advantage (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 Wellpoint Medicare Advantage (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $275.00 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 $7500.00 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 Wellpoint Medicare Advantage (HMO-POS) plan features an annual prescription drug deductible of $275. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when filling your prescriptions at a preferred pharmacy or through standard mail order. If you use a standard retail pharmacy, Tier 1 copays start at $5 and Tier 2 copays start at $10 for a one-month supply. Higher-tier medications are subject to coinsurance rather than flat copayments. You will pay a 25% coinsurance for Tier 3 preferred brand drugs and a 30% coinsurance for Tier 4 non-preferred drugs at preferred, standard, and mail-order pharmacies. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply.
Additional Benefits
The Wellpoint Medicare Advantage (HMO-POS) plan provides comprehensive healthcare coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $415 daily copay for the first five days and no copay for additional days, while outpatient services range from no copay up to a $415 copay. Emergency room visits carry a $115 copay, and urgent care is available for a $40 copay, both featuring no coinsurance. Specialist visits and Medicare-covered hearing exams require a $45 copay, but routine dental, vision, and hearing services are covered with no copays. The plan also covers durable medical equipment with coinsurance ranging from 0% to 20%, while diabetic supplies feature no copay and no coinsurance. Skilled nursing facility care is also available with no copay for the first 20 days, followed by a $218 daily copay up to day 100.
Inpatient Hospital See details
Inpatient hospital services are covered by Wellpoint Medicare Advantage (HMO-POS) with no coinsurance, requiring a $415 daily copay for days 1 through 5 and no copay for days 6 and beyond for both acute and psychiatric stays. Prior authorization is required, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Wellpoint Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $415 copay for outpatient hospital services and a $415 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $45 copay with no coinsurance.
Partial Hospitalization See details
Wellpoint Medicare Advantage (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Wellpoint Medicare Advantage (HMO-POS) with a $325 copay and no coinsurance for ground and air ambulance transport, which requires prior authorization. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Wellpoint Medicare Advantage (HMO-POS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered up to a $100,000 lifetime maximum, with a $115 copay and no coinsurance per service.
Primary Care See details
Wellpoint Medicare Advantage (HMO-POS) offers primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist, psychiatric, and mental health services require a $45 copay and no coinsurance. Physical, occupational, and speech therapy services have a $35 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Wellpoint Medicare Advantage (HMO-POS) covers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, remote access technologies, and glaucoma screenings. This benefit is partially covered, as it excludes services such as fitness benefits, health education, in-home safety assessments, personal emergency response systems, and nutritional/dietary counseling.
Hearing Services See details
Wellpoint Medicare Advantage (HMO-POS) hearing services require prior authorization and feature no coinsurance, with a $45 copay for Medicare-covered exams and no copay for routine exams, fitting evaluations, and hearing aids. Prescription hearing aids are partially covered up to $2,000 annually, excluding inner ear, outer ear, and over the ear types, while OTC hearing aids are covered with no copay up to a $300 annual limit.
Vision Services See details
Vision services are partially covered by Wellpoint Medicare Advantage (HMO-POS), offering no coinsurance and copays ranging from $0 to $45. Routine annual eye exams and eyewear—including lenses, frames, and contacts up to a $100 yearly limit—feature no copay, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Wellpoint Medicare Advantage (HMO-POS) offers partially covered dental services up to a $1,000 annual maximum, featuring no copay and no coinsurance for preventive care. Comprehensive treatments such as restorative care and oral surgery are covered with no copay and a 25% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellpoint Medicare Advantage (HMO-POS) with no copay, though prior authorization is required and associated Part B chemotherapy and other drugs carry a 0% to 20% coinsurance. Covered Medicare Part B insulin is available with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellpoint Medicare Advantage (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellpoint Medicare Advantage (HMO-POS), including durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and diabetic supplies with no copay and no coinsurance. Prosthetic devices and medical supplies are also covered with no copay and 20% coinsurance, though prior authorization is required for some items.
Diagnostic and Radiological Services See details
Wellpoint Medicare Advantage (HMO-POS) covers diagnostic and radiological services with prior authorization required. Lab services feature no copay and no coinsurance, while diagnostic tests and procedures have a copay ranging from $0 to $100 with no coinsurance. Outpatient X-rays require a $45 copay, diagnostic radiological services have a minimum $45 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Wellpoint Medicare Advantage (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellpoint Medicare Advantage (HMO-POS) with no coinsurance and prior authorization, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, and SET for PAD services are not covered and require a $20 copay, while pulmonary rehabilitation services are also not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Wellpoint Medicare Advantage (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no prior three-day hospital stay required.
Other Services See details
Other services are partially covered by Wellpoint Medicare Advantage (HMO-POS), featuring a chronic illness meal benefit with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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