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Wellpoint Medicare Advantage 2 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Medicare Advantage 2 (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 2 (HMO-POS) in 2026, please refer to our full plan details page.
Wellpoint Medicare Advantage 2 (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 3.5 out of 5 stars in 2026.
It's important to know that Wellpoint Medicare Advantage 2 (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 2 (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 2 (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 $8300.00 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 2 (HMO-POS) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies or through standard mail, while standard pharmacies require a $2 copay. Other tiers require coinsurance, ranging from 15% for standard generics up to 33% for non-preferred drugs, though Tier 5 specialty drugs have no copay. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, individuals who qualify for the low-income subsidy can reduce their Part D premium to $0. This structured coverage ensures predictable costs for your essential medications throughout the year.
Additional Benefits
The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copay or coinsurance for primary care visits, telehealth, and preventive services. For inpatient hospital stays, members pay a $295 daily copay for the first six days and no copay for days 7 through 90, while outpatient services carry no coinsurance and copays up to $230. Emergency care is accessible with a $115 copay, which is waived upon admission, and urgent care requires a low $15 copay. In addition to core medical care, this plan provides routine dental, vision, and hearing services with no copayments, alongside allowances for eyewear and hearing aids. Members also enjoy no copays or coinsurance for home health services, dialysis, and up to 12 one-way transportation trips to approved locations. While most benefits feature no coinsurance, durable medical equipment requires up to a 20% coinsurance, and comprehensive dental services require a 25% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Wellpoint Medicare Advantage 2 (HMO-POS), as upgrades and non-Medicare-covered stays are not covered. For covered acute and psychiatric hospital stays, there is a $295 daily copay for days 1 through 6, no copay for days 7 through 90, and no coinsurance.
Outpatient Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers outpatient services with no coinsurance, though copays vary depending on the specific service. Patients will pay a copay ranging from $0 to $230 for outpatient hospital services, $230 per stay for observation services, and $25 for outpatient substance abuse sessions, while ambulatory surgical center and outpatient blood services have no copay.
Partial Hospitalization See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers partial hospitalization benefits with a $30 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers ambulance services with a $195 copay and no coinsurance per ground or air trip. Transportation services are partially covered, offering up to 12 one-way trips 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 2 (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care requires a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with a $115 copay and no coinsurance.
Primary Care See details
Wellpoint Medicare Advantage 2 (HMO-POS) offers primary care and telehealth services with no copay and no coinsurance, while other specialty, therapy, and psychiatric services require copays ranging from $0 to $35 with no coinsurance. Chiropractic benefits are partially covered with a $15 copay and no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are partially covered by Wellpoint Medicare Advantage 2 (HMO-POS), featuring an annual physical exam, kidney disease education, memory fitness, and select screenings with no copay or coinsurance. However, several supplemental benefits are not covered, including health education, in-home safety assessments, personal emergency response systems, and weight management programs.
Hearing Services See details
Hearing services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no copay, coinsurance, or deductible for routine exams, fitting evaluations, and over-the-counter hearing aids up to a $300 annual limit. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 annually, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Wellpoint Medicare Advantage 2 (HMO-POS), as eyewear upgrades are not covered. Routine eye exams and eyewear—including contacts, lenses, and frames up to a $150 annual limit—have no copay and no coinsurance, while other eye exams require a copay of up to $35 with no coinsurance.
Dental Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) offers partially covered dental services, with no coverage for maxillofacial prosthetics, implant services, and orthodontics. Preventive dental care has no copay and no coinsurance up to a $500 annual limit, while covered comprehensive services require a 25% coinsurance with no copay, and Medicare-covered dental services have a $0 to $35 copay with no coinsurance.
Home Infusion bundled Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers home infusion bundled services with prior authorization, requiring a $35 copay and no coinsurance for Medicare Part B insulin. Other covered Part B chemotherapy, radiation, and miscellaneous drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no copay and no coinsurance required for these treatments.
Medical Equipment See details
Medical equipment is covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no copays, though prior authorization is required for these services. Durable medical equipment, prosthetics, and medical supplies carry a coinsurance ranging from no coinsurance to 20%, while diabetic supplies and therapeutic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers diagnostic and radiological services with prior authorization required. Diagnostic tests, procedures, and lab services have no copay, while outpatient X-rays require a $15 copay, diagnostic radiological services have a copay up to $195, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) does not cover Cardiac Rehabilitation Services in practice, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Wellpoint Medicare Advantage 2 (HMO-POS), featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) partially covers Other Services, providing covered benefits like over-the-counter items, meal benefits, and community resource support with no copay and no coinsurance. Acupuncture and dual eligible SNPs with highly integrated services are not covered under this plan.
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