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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 Select Counties in TX. 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.

Overview IconKey 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 $9350.00 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:

Regular visits to your primary care doctor are covered and will have a copay of $0.00 and coinsurance of 0% (no coinsurance).

Specialist Visits:

Visits to specialists are covered and will have a copay of $30.00 and coinsurance of 0% (no coinsurance). Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a copay of $110.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care arecovered and will have a copay of $35.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for Wellpoint Medicare Advantage 2 (HMO-POS)

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Drug Coverage IconDrug Coverage

The Wellpoint Medicare Advantage 2 (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $2 copay at preferred pharmacies, while standard generic drugs have 20% coinsurance at both preferred and standard pharmacies. In the catastrophic coverage phase, after your total drug costs reach $2000, you will 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 IconAdditional Benefits

The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. Emergency, urgent, and worldwide emergency services are covered with copays, and primary care, preventive services, and many other services have no copay. Vision services cover eye exams and eyewear with copays or coinsurance, while dental services offer oral exams and cleaning with no copay. This plan also provides coverage for ambulance services, home health services, and skilled nursing facilities. Prescription drugs are covered with copays or coinsurance, and durable medical equipment, diagnostic services, and dialysis services are also covered. The plan includes additional benefits such as OTC items, with specific coverage limitations.

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization; for days 1-6, the copay is $335, and for days 7-90, there is no copay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stay and upgrades are not covered.

Outpatient Services See details

Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $335, observation services have a $335 copay, and ASC services have no copay. Individual and group sessions for outpatient substance abuse have a $35 copay, and outpatient blood services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan, but requires prior authorization. You will have a $35 copay for this service.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. Ground and air ambulance services each have a $260 copay, with no coinsurance, while 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 by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $35 copay; both have no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay and no coinsurance, with a maximum benefit of $100,000.

Primary Care See details

The Wellpoint Medicare Advantage 2 (HMO-POS) plan offers primary care services with no copay, and chiropractic services with a $15 copay. Occupational therapy services have a $30 copay, while physician specialist services have a $30 copay. Mental health specialty services and psychiatric services have a $35 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have no copay, and opioid treatment program services have a copay of $35.

Preventive Services See details

Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay, but other services like Health Education, In-Home Safety Assessment, and others are not covered.

Hearing Services See details

Hearing services include hearing exams with a $30 copay, but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.

Vision Services See details

Vision services include eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eye exams have a copay of $0-$30, and eyewear has a 20% coinsurance, and a copay for eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Contact lenses have no copay, and upgrades are not covered.

Dental Services See details

Dental services include oral exams with no copay, and prophylaxis (cleaning) with no copay. Medicare dental services have a $30 copay and require prior authorization. Dental X-rays and fluoride treatment are offered as optional, supplemental benefits, which may require additional payment. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered under the Wellpoint Medicare Advantage 2 (HMO-POS) plan. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan. Durable Medical Equipment (DME) has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have no copay and a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $20 and $150, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $20 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; however, additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.

Cardiac Rehabilitation Services See details

Wellpoint Medicare Advantage 2 (HMO-POS) does not cover cardiac rehabilitation services, including intensive cardiac rehabilitation services, pulmonary rehabilitation services, and supervised exercise therapy (SET) for PAD services. Prior authorization is required for these services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Wellpoint Medicare Advantage 2 (HMO-POS) plan, with prior authorization required. For days 1-20, there is no copay, but for days 21-100, the copay is $214.

Other Services See details

Other Services for the Wellpoint Medicare Advantage 2 (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay and a maximum benefit coverage amount of $32.00 every three months. Acupuncture, meal benefits, 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. Other 1 benefits are covered with no copay and require a doctor's referral.

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