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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 2025 to people living in Maricopa and surrounding counties. This plan received an overall rating of 3 out of 5 stars in 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 $200.00 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 $3000.00 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 Enhanced Alternative drug benefit with a yearly prescription drug deductible of $200.00. During the initial coverage phase, there is no copay for Tier 1 preferred generic drugs at preferred pharmacies or through standard mail, while standard pharmacies require a $10.00 copay. For higher tiers, including standard generics, preferred brands, and non-preferred drugs, you will pay a coinsurance of 25% to 30% depending on the drug tier. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy, also known as Extra Help, will see their Part D premium reduced to $0.00. This plan provides clear cost-sharing options to help you effectively manage your prescription medication expenses.
Additional Benefits
The Wellpoint Medicare Advantage (HMO-POS) plan offers comprehensive coverage for everyday healthcare needs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits and outpatient therapies require copays between $15 and $30 with no coinsurance, while inpatient hospital stays have a $175 daily copay for the first seven days and no copay thereafter. Emergency care is covered with a $150 copay, and urgent care visits require a $40 copay, with no coinsurance for either service. Additional benefits include routine dental, vision, and hearing care, with no copay for annual exams and generous annual allowances for eyewear and hearing aids. Preventive dental services require no copay, while comprehensive dental is covered up to a $750 limit with a 25% coinsurance. Essential needs like medical equipment and dialysis require no copay and up to 20% coinsurance, and the plan includes up to 72 one-way transportation trips per year with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Wellpoint Medicare Advantage (HMO-POS) with a $175 daily copay for days 1 through 7, no copay for days 8 through 90, and no coinsurance. While acute and psychiatric inpatient stays are covered, non-Medicare-covered stays and room upgrades are not covered.
Outpatient Services See details
Wellpoint Medicare Advantage (HMO-POS) covers outpatient services with no coinsurance and varying copays. There is no copay for ambulatory surgical center and blood services, a $25 copay for outpatient substance abuse sessions, and a copay of $0 to $175 for outpatient hospital and observation services.
Partial Hospitalization See details
Wellpoint Medicare Advantage (HMO-POS) covers partial hospitalization services with a $30 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Wellpoint Medicare Advantage (HMO-POS), with ground and air ambulance services requiring a $275 copay and no coinsurance. Transportation to plan-approved health-related locations is covered with no copay and no coinsurance for up to 72 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Wellpoint Medicare Advantage (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 are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 lifetime limit with a $150 copay and no coinsurance.
Primary Care See details
Wellpoint Medicare Advantage (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialists, therapies, and mental health visits require copays between $15 and $30 and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Wellpoint Medicare Advantage (HMO-POS) with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, and select screenings. Sub-services such as health education, weight management, alternative therapies, therapeutic massage, adult day health, in-home support, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Wellpoint Medicare Advantage (HMO-POS) with no copays, coinsurance, or deductibles, including annual routine exams, fitting evaluations, and up to $300 annually for over-the-counter hearing aids. Prescription hearing aids are partially covered up to $1,500 per year, but inner ear, outer ear, and over-the-ear devices are not covered.
Vision Services See details
Wellpoint Medicare Advantage (HMO-POS) offers partially covered vision services, including eye exams with no copay for routine visits (up to $20 for others) and eyewear covered up to $250 annually with no copay. There is no coinsurance or deductible for these services, but eyewear upgrades are not covered.
Dental Services See details
Wellpoint Medicare Advantage (HMO-POS) dental benefits are partially covered up to a $750 annual limit, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Preventive and diagnostic care has no copay and no coinsurance, Medicare-covered dental has a $20 copay and no coinsurance, and covered comprehensive services require no copay and a 25% coinsurance.
Home Infusion bundled Services See details
Wellpoint Medicare Advantage (HMO-POS) covers home infusion bundled services with prior authorization, offering chemotherapy, radiation, and other Part B drugs with no copay and no coinsurance to 20% coinsurance. Covered Medicare Part B insulin drugs require 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
Wellpoint Medicare Advantage (HMO-POS) covers medical equipment, including durable medical equipment with no copay and between no coinsurance and 20% coinsurance. Prosthetics and medical supplies are covered with no copay and a 20% coinsurance, while diabetic supplies and therapeutic shoes feature no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Medicare Advantage (HMO-POS) covers diagnostic and radiological services with prior authorizations and doctor referrals. Lab services have no copay or coinsurance, outpatient X-rays require a $15 copay with no coinsurance, therapeutic services require a 20% coinsurance with no copay, and diagnostic tests and radiology require copays ranging from $0 to $125 with no coinsurance.
Home Health Services See details
Home Health Services are covered by Wellpoint Medicare Advantage (HMO-POS) with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Wellpoint Medicare Advantage (HMO-POS) plan, meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD services.
Skilled Nursing Facility (SNF) See details
Wellpoint Medicare Advantage (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with prior authorization, requiring no copay and no coinsurance for days 1 through 20, and a $218 daily copay with no coinsurance for days 21 through 100. Additional days beyond Medicare-covered SNF care are not covered.
Other Services See details
Other Services are partially covered by Wellpoint Medicare Advantage (HMO-POS), featuring no copay and no coinsurance for covered benefits like over-the-counter items, meal benefits, and community resource support. However, acupuncture and Dual Eligible SNPs with highly integrated services are not covered.
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