A non-government entity
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 Select Counties in TX. 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 a $300.00 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 $9250.00 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:
Sign up for Wellpoint Medicare Advantage 2 (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellpoint Medicare Advantage 2 (HMO-POS) plan features an annual drug deductible of $300. Beneficiaries will enjoy no copay for Tier 1 Preferred Generic and Tier 6 Select Care drugs at preferred, standard, and standard mail-order pharmacies. For Tier 2 Generic drugs, standard mail order also offers no copay, while retail copays range from $2 to $7 for a one-month supply. Higher-tier medications require coinsurance during the initial coverage phase. Tier 3 Preferred Brand drugs carry a 20% coinsurance at preferred pharmacies and standard mail order, or 25% at standard pharmacies. Tier 4 Non-Preferred drugs require 30% coinsurance, and Tier 5 Specialty drugs have a 29% coinsurance for a one-month supply.
Additional Benefits
The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers affordable medical coverage with no copay or coinsurance for primary care visits, telehealth, and preventive services. For inpatient hospital stays, members pay a $335 daily copay for the first six days and no copay thereafter, while outpatient hospital services range from no copay up to a $335 copay. Emergency care is available with a $115 copay, which is waived if you are admitted, and ground or air ambulance services require a $276 copay. This plan also includes essential supplemental benefits, featuring preventive dental care and annual routine vision exams with no copay or coinsurance, alongside a $100 annual eyewear allowance. Home health services and diabetic supplies are fully covered with no copay or coinsurance. Additionally, members receive an over-the-counter benefit of up to $44 every three months with no copay to help cover everyday health and wellness items.
Inpatient Hospital See details
Wellpoint Medicare Advantage 2 (HMO-POS) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $335 daily copay for days 1 through 6 and no copay for days 7 through 90 and beyond. Prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan feature no coinsurance across all services, with no copay for ambulatory surgical center (ASC) and outpatient blood services. Outpatient hospital services require a copay of $0 to $335 (including $335 per stay for observation services), while outpatient substance abuse individual and group sessions carry a $35 copay.
Partial Hospitalization See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers partial hospitalization services with a $35.00 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 under Wellpoint Medicare Advantage 2 (HMO-POS), as transportation to plan-approved or any health-related locations is not covered. Covered ground and air ambulance services require prior authorization and have a $276 copay with no coinsurance.
Emergency Services See details
Emergency services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $35 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) features primary care and telehealth visits with no copay and no coinsurance, while specialist, therapy, psychiatric, and opioid treatment services have copays ranging from $20 to $35 with no coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no copays and no coinsurance for annual physical exams, kidney disease education, remote access technologies, and select screenings, though some services require a referral. However, several supplemental benefits are not covered, including fitness benefits, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, home safety modifications, and counseling services.
Hearing Services See details
Hearing services are partially covered by Wellpoint Medicare Advantage 2 (HMO-POS), with covered hearing exams requiring a $30 copay, no coinsurance, and no deductible, though prior authorization and a referral are required. While some services are covered, routine hearing exams, fitting or evaluation for hearing aids, OTC hearing aids, and all types of prescription hearing aids (including inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
Vision Services are partially covered by Wellpoint Medicare Advantage 2 (HMO-POS), featuring one annual routine eye exam with no copay and no coinsurance, while other eye exams are not covered. Covered eyewear has a $100 annual limit and no deductible, offering eyeglasses and lenses with no copay or coinsurance, contact lenses with a 20% coinsurance and no copay, and no coverage for upgrades.
Dental Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) offers partially covered dental services, featuring Medicare-covered dental with a $30 copay and no coinsurance, and preventive services like oral exams, cleanings, x-rays, and fluoride with no copay or coinsurance. However, other diagnostic, restorative, endodontic, periodontic, prosthodontic, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no copay and 0% to 20% coinsurance for durable medical equipment, and no copay with 20% coinsurance for prosthetics and medical supplies. Diabetic equipment, supplies, and therapeutic shoes are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers diagnostic and radiological services, with prior authorization and referrals required. Diagnostic tests and procedures have a copay of $0 to $150 with no coinsurance, lab services have no copay or coinsurance, and radiological services require a $20 copay for X-rays, a $20 minimum copay for diagnostic radiology, and a 20% minimum coinsurance for therapeutic radiology.
Home Health Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under Wellpoint Medicare Advantage 2 (HMO-POS) and require prior authorization, though some services are covered while standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Wellpoint Medicare Advantage 2 (HMO-POS) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, admission does not require a prior three-day hospital stay, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Wellpoint Medicare Advantage 2 (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and Medicare Community Resource Support with no copay and no coinsurance. The OTC benefit provides up to $44 of coverage every three months, while acupuncture and meal benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved