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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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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 has an "Enhanced Alternative" drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $7.50 copay at preferred pharmacies and a $0 copay at standard mail pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellpoint Medicare Advantage 1 (HMO-POS) plan offers comprehensive coverage with a variety of benefits. It includes coverage for inpatient and outpatient services, with varying copays depending on the service. You'll also find coverage for services like dental, vision, and hearing, often with no copays or low copays, plus additional benefits such as ambulance services, over-the-counter items, and meal benefits.
Inpatient Hospital See details
The Wellpoint Medicare Advantage 1 (HMO-POS) plan covers inpatient hospital stays, including services not usually covered by Medicare plans. For inpatient hospital-acute and inpatient hospital psychiatric, you will pay a $200 copay for days 1-5, and no copay for days 6-90. Additional days for both inpatient hospital-acute and psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for inpatient hospital-acute and psychiatric are not covered.
Outpatient Services See details
Outpatient Services including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient Hospital Services have a copay between $0 and $175, Observation Services have a $175 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse each have a $30 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Medicare Advantage 1 (HMO-POS) plan. You will pay a $30 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Wellpoint Medicare Advantage 1 (HMO-POS) plan. Ground and air ambulance services have a copay of $195, while transportation services to a plan-approved health-related location have no copay and cover up to 72 one-way trips per year via rideshare services, bus/subway, van, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Medicare Advantage 1 (HMO-POS) plan. Emergency Services has a $120 copay, while Urgently Needed Services has a $15 copay, and both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay, and the plan has a maximum benefit coverage of $100,000 for worldwide services.
Primary Care See details
Under the Wellpoint Medicare Advantage 1 (HMO-POS) plan, primary care physician services have no copay, chiropractic services have a $20 copay, and occupational therapy services have a $15 copay. Physician specialist services have a copay between $0 and $35, while mental health specialty services, podiatry services, other health care professional services, and psychiatric services have varying copays. Physical therapy and speech-language pathology services have a copay between $0 and $15, additional telehealth benefits have no copay, and opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive services are covered, including annual physical exams with no copay. Fitness benefits, remote access technologies, and home and bathroom safety devices and modifications are covered, but other preventive services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The Wellpoint Medicare Advantage 1 (HMO-POS) plan covers hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and OTC hearing aids with no copay. Prescription hearing aids are covered, but the plan has a maximum benefit of $1500 per year for both ears combined, and some types of prescription hearing aids are not covered.
Vision Services See details
The Wellpoint Medicare Advantage 1 (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay. Eyewear includes contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $225 per year.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay. Other dental services have a maximum plan benefit of $500 per year, and Medicare dental services require prior authorization and have a copay of $0-$35.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Medicare Advantage 1 (HMO-POS) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics, Medical Supplies, and Diabetic Equipment, is covered by the Wellpoint Medicare Advantage 1 (HMO-POS) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, while Diabetic Supplies have a 20% coinsurance and Diabetic Therapeutic Shoes/Inserts have a $25 copay.
Diagnostic and Radiological Services See details
The Wellpoint Medicare Advantage 1 (HMO-POS) plan covers diagnostic and radiological services, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with a copay up to $150, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $15 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Wellpoint Medicare Advantage 1 (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Medicare Advantage 1 (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, and a $75 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Wellpoint Medicare Advantage 1 (HMO-POS) plan covers over-the-counter items with no copay, and a maximum benefit coverage amount of $100 every three months. The plan also covers a meal benefit with no copay, but requires prior authorization. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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