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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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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 has a $0 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 $3 copay at preferred pharmacies, while standard mail order generic drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Wellpoint Medicare Advantage (HMO-POS) plan offers a wide range of benefits. It covers inpatient hospital stays with a $175 copay for days 1-7, and no copay for days 8-90, and outpatient services with varying copays. This plan also includes coverage for emergency services, primary care, preventive services, and hearing, vision, and dental services, all with varying costs and copays. Additional benefits include ambulance and transportation services, home health services with no copay, and skilled nursing facility services with no copay for days 1-20. The plan also includes coverage for home infusion, medical equipment, and diagnostic services, with some services requiring a copay or coinsurance. Furthermore, the plan covers OTC items, meal benefits, and hearing aids, with a maximum annual benefit for hearing aids and eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization required. For days 1-7, the copay is $175, and for days 8-90, there is no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $175, observation services have a $175 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a $30 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Wellpoint Medicare Advantage (HMO-POS) plan, but requires prior authorization. You will pay a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Wellpoint Medicare Advantage (HMO-POS), including both ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance, and transportation services have no copay. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Urgently Needed Services have a $40 copay, and there is a $100,000 maximum benefit for Worldwide Emergency Services.
Primary Care See details
The Wellpoint Medicare Advantage (HMO-POS) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $15 copay, Physician Specialist Services with a $20 copay, and Mental Health Specialty Services with a $25 copay for individual and group sessions. This plan also covers Podiatry Services and Other Health Care Professional services with varying copays, Physical Therapy and Speech-Language Pathology Services with a $15 copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $30 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar services, annual physical exams with no copay, and additional preventive services. Other preventive services include no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with no copay, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a plan-specified amount of $1,500 per year. OTC hearing aids are covered with no copay, up to $300 per year.
Vision Services See details
Vision services include eye exams with a copay of $0-$20, and eyewear with no copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have no copay, and upgrades are covered as well. Eyewear has a combined maximum benefit of $300 per year.
Dental Services See details
The Wellpoint Medicare Advantage (HMO-POS) plan covers dental services, including Medicare Dental Services with a $20 copay, and other dental services with a maximum benefit of $750 per year. 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 are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Other Medicare Part B drugs have a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment (DME), is covered with a coinsurance between 0% and 20%, though DME for use outside the home is not covered. Prosthetic devices and medical supplies are covered, with a 20% coinsurance for medical supplies and a coinsurance between 20% for prosthetic devices. Diabetic equipment is covered, including diabetic supplies and diabetic therapeutic shoes/inserts, with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures, tests, and lab services, and no copay for lab services. Diagnostic Procedures/Tests have a copay between $0 and $30, and Diagnostic Radiological Services have a copay between $15 and $125. Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Wellpoint Medicare Advantage (HMO-POS) covers Home Health Services 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 not covered by the Wellpoint Medicare Advantage (HMO-POS) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $196.
Other Services See details
The Wellpoint Medicare Advantage (HMO-POS) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit of $68 every three months; it also covers meal benefits with no copay, and other services with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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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