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Wellpoint Medicare Advantage 1 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Medicare Advantage 1 (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 1 (HMO-POS) in 2026, please refer to our full plan details page.
Wellpoint Medicare Advantage 1 (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Pima County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellpoint Medicare Advantage 1 (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 1 (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 1 (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 $125.00 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 $2700.00 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 1 (HMO-POS) plan features an annual prescription drug deductible of $125.00. During the initial coverage phase, you will enjoy no copay for preferred generic drugs at preferred pharmacies and standard mail-order services, as well as no copay for specialty tier drugs. Other medications require coinsurance, ranging from 25% for standard generics to 31% for non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy can benefit from a Part D premium reduction and pay nothing for their covered drugs.
Additional Benefits
The Wellpoint Medicare Advantage 1 (HMO-POS) plan offers comprehensive medical coverage with affordable out-of-pocket costs, featuring no copay for primary care visits, telehealth, and preventive services. If you require hospital care, inpatient stays carry a $200 daily copay for the first five days and no copay thereafter, while outpatient hospital services range from no copay up to a $175 copay. Emergency care is available with a $150 copay, which is waived if you are admitted, and urgent care visits require a low $15 copay. For additional wellness needs, the plan provides no copay for routine eye exams, eyewear, and preventive dental care, alongside a 25% coinsurance with no copay for comprehensive dental services. You also benefit from no copay on home health services, dialysis, and up to 72 one-way transportation trips to approved health locations per year. Additionally, skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Wellpoint Medicare Advantage 1 (HMO-POS) partially covers inpatient hospital acute and psychiatric services with a $200 copay per day for days 1 through 5, no copay for days 6 and beyond, and no coinsurance. Prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Wellpoint Medicare Advantage 1 (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $175 copay for outpatient hospital services and a $175 copay per stay for observation services. Outpatient substance abuse sessions require a $25 copay, while ambulatory surgical center and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Wellpoint Medicare Advantage 1 (HMO-POS) with a $30 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Wellpoint Medicare Advantage 1 (HMO-POS) covers ground and air ambulance services with a $195 copay and no coinsurance, though prior authorization is required. Transportation services are partially covered, offering up to 72 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Wellpoint Medicare Advantage 1 (HMO-POS) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $15 copay and no coinsurance, while worldwide emergency care, urgent care, and transportation are covered up to a $100,000 maximum limit with a $150 copay.
Primary Care See details
Wellpoint Medicare Advantage 1 (HMO-POS) covers primary care physician and telehealth visits with no copay and no coinsurance, while other services like specialist, therapy, and mental health visits require copays ranging from $0 to $30 with no coinsurance. Chiropractic benefits are partially covered, as routine chiropractic care is not covered.
Preventive Services See details
Wellpoint Medicare Advantage 1 (HMO-POS) partially covers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, and select screenings. Uncovered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by Wellpoint Medicare Advantage 1 (HMO-POS) with no copay and no coinsurance for exams, fittings, and covered hearing aids, though inner ear, outer ear, and over-the-ear prescription models are not covered. The plan provides up to $1,500 annually for prescription hearing aids and up to $300 annually for over-the-counter hearing aids, both of which require prior authorization.
Vision Services See details
Wellpoint Medicare Advantage 1 (HMO-POS) partially covers vision services with no deductibles or coinsurance, though eyewear upgrades are not covered. Routine eye exams and eyewear, including lenses, frames, and contacts, have no copay with a $225 annual maximum, while other eye exams require a copay of $0 to $30.
Dental Services See details
Wellpoint Medicare Advantage 1 (HMO-POS) provides partially covered dental services, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Preventive care is offered with no copay and no coinsurance up to a $500 annual limit, while Medicare-covered dental requires a $0 to $30 copay with no coinsurance, and covered comprehensive services have a 25% coinsurance and no copay.
Home Infusion bundled Services See details
Wellpoint Medicare Advantage 1 (HMO-POS) covers home infusion bundled services, which require prior authorization. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Wellpoint Medicare Advantage 1 (HMO-POS) covers Dialysis Services with no copay, though coinsurance information is not specified. This benefit ensures you can receive necessary dialysis treatments without any copayment costs.
Medical Equipment See details
Medical equipment is covered by Wellpoint Medicare Advantage 1 (HMO-POS) with prior authorization required for most items. Durable medical equipment, prosthetics, and medical supplies carry no copay and a coinsurance ranging from no coinsurance to 20%. Diabetic supplies require a 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts have a $25 copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Medicare Advantage 1 (HMO-POS) covers diagnostic procedures, tests, and lab services with no copay or coinsurance, though prior authorization is required. Diagnostic radiological services have a copay of up to $150, outpatient X-rays require a $15 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellpoint Medicare Advantage 1 (HMO-POS) with no copay and no coinsurance. Prior authorization is required to access these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Wellpoint Medicare Advantage 1 (HMO-POS) plan with a copay and no coinsurance, subject to prior authorization. Although some services are covered, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services in practice.
Skilled Nursing Facility (SNF) See details
Wellpoint Medicare Advantage 1 (HMO-POS) covers Skilled Nursing Facility (SNF) services with prior authorization, featuring no copay or coinsurance for days 1 through 20, and a $218 daily copay with no coinsurance for days 21 through 100. This benefit is partially covered, as additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Wellpoint Medicare Advantage 1 (HMO-POS) other services are partially covered, with acupuncture and dual eligible SNPs with highly integrated services excluded from coverage. Covered benefits, including over-the-counter items, meal benefits, and Medicare community resource support, are offered with no copay and no coinsurance.
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