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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 2025, 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 2025.
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 has an enhanced alternative drug benefit with no deductible. In the initial coverage phase, you'll pay a $4 copay for preferred generic drugs at a preferred pharmacy, and 20% coinsurance for standard generic drugs. You will pay no copay for preferred generic drugs through the mail order service. For preferred brand drugs and non-preferred drugs, you'll pay 25% and 33% coinsurance, respectively. The plan has no copay for specialty tier drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers a variety of benefits with varying costs. This plan includes coverage for inpatient and outpatient services, with copays ranging from $0 to $295, depending on the service. It also includes coverage for dental, vision, and hearing services, with no copays for many of these services, and maximum benefits of up to $1000 for hearing aids and $150 for eyewear. This plan provides additional benefits such as ambulance, transportation, emergency, primary care, preventive, and home health services with varying cost-sharing. The plan also covers medical equipment, diagnostic services, and skilled nursing facility (SNF) services. Additional perks include over-the-counter (OTC) items, with a maximum benefit of $15 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $295 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, there is a $295 copay for days 1-6, and no copay for days 7-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and the same is true for Non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $295, observation services have a $295 copay, and ASC services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $30. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $195 copay. Transportation Services to plan-approved health-related locations are covered with no copay, up to 12 one-way trips per year, using rideshare services, bus/subway, van, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay, and Urgently Needed Services have a $15 copay, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $90 copay.
Primary Care See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay, but routine chiropractic care is not covered. Occupational therapy services have a $15 copay, and physician specialist services have a copay between $0 and $35. Individual and group sessions for mental health specialty services have a copay between $0 and $25, while podiatry services have a copay between $0 and $35. Other health care professional services have a copay between $0 and $20, and individual and group sessions for psychiatric services have a copay between $0 and $35. 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 include annual physical exams with no copay, and additional preventive services, including Fitness Benefit and Remote Access Technologies with a $0 copay. Some services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams and OTC hearing aids have no copay, while prescription hearing aids have a plan-specified amount up to $1000, and OTC hearing aids have a maximum of $300. Routine hearing exams and fitting/evaluation for hearing aids also have no copay.
Vision Services See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers vision services, including routine eye exams with a copay of $0-$35, and eyewear with a $0 copay. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $150 every year, but upgrades are not covered.
Dental Services See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. The plan also covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics with no copay. Other dental services have a maximum benefit of $200 per year.
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 with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a coinsurance between 0% and 20%, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies and Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests with no copay, and lab services with no copay. Diagnostic Radiological Services have a copay of up to $195, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan with no copay and no coinsurance, though 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 of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. There is no copay for days 1-20, and a $75 copay for days 21-100. Services beyond Medicare-covered days and non-Medicare-covered stays are not covered.
Other Services See details
The Wellpoint Medicare Advantage 2 (HMO-POS) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $15 every three months. Meal benefits and other services are also covered with no copay, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many other services are not covered.
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